Provider Demographics
NPI:1265426720
Name:DEVENNY, LEISA W (MD)
Entity type:Individual
Prefix:DR
First Name:LEISA
Middle Name:W
Last Name:DEVENNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 934370
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-0001
Mailing Address - Country:US
Mailing Address - Phone:800-897-6169
Mailing Address - Fax:800-897-6170
Practice Address - Street 1:809 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2029
Practice Address - Country:US
Practice Address - Phone:205-759-7111
Practice Address - Fax:205-343-8549
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2024-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL18211207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000078713Medicaid
AL78713Medicare ID - Type Unspecified