Provider Demographics
NPI:1356494298
Name:EAST ALABAMA PHYSICIANS, LLC
Entity Type:Organization
Organization Name:EAST ALABAMA PHYSICIANS, LLC
Other - Org Name:EAST ALABAMA PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:334-528-1310
Mailing Address - Street 1:2740 VILLAGE PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-2379
Mailing Address - Country:US
Mailing Address - Phone:334-821-0238
Mailing Address - Fax:334-821-6685
Practice Address - Street 1:2740 VILLAGE PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2379
Practice Address - Country:US
Practice Address - Phone:334-821-0238
Practice Address - Fax:334-821-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529905580Medicaid
AL010029OtherBLUE CROSS - BLUE SHIELD