Provider Demographics
NPI:1659183739
Name:PRICE, JAELEE AUTUMN
Entity type:Individual
Prefix:
First Name:JAELEE
Middle Name:AUTUMN
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 WALKER BUILDING
Mailing Address - Street 2:
Mailing Address - City:AUBURN UNIVERSITY
Mailing Address - State:AL
Mailing Address - Zip Code:36849-0001
Mailing Address - Country:US
Mailing Address - Phone:334-844-8348
Mailing Address - Fax:
Practice Address - Street 1:2460 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-1510
Practice Address - Country:US
Practice Address - Phone:334-737-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS14489390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program