Provider Demographics
NPI:1528564424
Name:HAMRICK, YELIZAVETA AGAYEVA (DO)
Entity Type:Individual
Prefix:
First Name:YELIZAVETA
Middle Name:AGAYEVA
Last Name:HAMRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:AGAYEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1851 N MCKENZIE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-4703
Mailing Address - Country:US
Mailing Address - Phone:251-424-1232
Mailing Address - Fax:251-424-1954
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-424-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALDO.2037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program