Provider Demographics
NPI:1528321338
Name:BITTERLY, D'LISA ANN (MD)
Entity type:Individual
Prefix:
First Name:D'LISA
Middle Name:ANN
Last Name:BITTERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:D'LISA
Other - Middle Name:ANN
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2895
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-2895
Mailing Address - Country:US
Mailing Address - Phone:256-734-7850
Mailing Address - Fax:256-734-9633
Practice Address - Street 1:1930 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-734-7850
Practice Address - Fax:256-734-9633
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.46428208600000X
NE28577208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL305177Medicaid
AL305019Medicaid