Provider Demographics
NPI:1558714121
Name:NEUROLOGY CENTER OF EAST ALABAMA, LLC
Entity Type:Organization
Organization Name:NEUROLOGY CENTER OF EAST ALABAMA, LLC
Other - Org Name:NEUROLOGY CENTER OF EAST ALABAMA
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 1:2570 VILLAGE PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4742
Mailing Address - Country:US
Mailing Address - Phone:334-203-1917
Mailing Address - Fax:334-203-1918
Practice Address - Street 1:2570 VILLAGE PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4742
Practice Address - Country:US
Practice Address - Phone:334-203-1917
Practice Address - Fax:334-203-1918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST ALABAMA MEDICAL DEVELOPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-19
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty