Provider Demographics
NPI:1144325903
Name:LAMBERTH, SALLY FISK (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:FISK
Last Name:LAMBERTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-1913
Mailing Address - Country:US
Mailing Address - Phone:256-234-6401
Mailing Address - Fax:256-234-6191
Practice Address - Street 1:6 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-1913
Practice Address - Country:US
Practice Address - Phone:256-234-6401
Practice Address - Fax:256-234-6191
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL90584OtherBLUE CROSS BLUE SHIELD