Provider Demographics
NPI:1508412685
Name:LIPSCOMB CORNELIUS, COURTNEY GRACE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:GRACE
Last Name:LIPSCOMB CORNELIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:GRACE
Other - Last Name:LIPSCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 GARMON RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-9090
Mailing Address - Country:US
Mailing Address - Phone:256-553-1693
Mailing Address - Fax:
Practice Address - Street 1:1007 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1195
Practice Address - Country:US
Practice Address - Phone:256-494-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-146216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily