Provider Demographics
NPI:1588803811
Name:EAST ALABAMA ENDOCRINOLOGY, P.C.
Entity Type:Organization
Organization Name:EAST ALABAMA ENDOCRINOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-737-2737
Mailing Address - Street 1:3320 SKYWAY DR STE 602
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7138
Mailing Address - Country:US
Mailing Address - Phone:334-737-2737
Mailing Address - Fax:334-821-1043
Practice Address - Street 1:3320 SKYWAY DR
Practice Address - Street 2:SUITE 808
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7137
Practice Address - Country:US
Practice Address - Phone:334-737-2737
Practice Address - Fax:334-821-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty