Provider Demographics
NPI:1225208507
Name:EAST ALABAMA PSYCHIATRIC
Entity Type:Organization
Organization Name:EAST ALABAMA PSYCHIATRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SYSTEMS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:DUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-528-1387
Mailing Address - Street 1:PO BOX 4310
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36803-4310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3320 SKYWAY DR
Practice Address - Street 2:SUITE 801
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7137
Practice Address - Country:US
Practice Address - Phone:334-749-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST ALABAMA HEALTHCARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-03
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI376OtherMEDICARE