Individual
AVERY BERLIN LISENBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 PEPPERELL PKWY, OPELIKA, AL 36801-5452
(334) 528-1112
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
42332
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2018
Last updated
06/15/2021
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