MEDICARE: ETERNA PRIMARY CARE OF ALABAMA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1982554978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETERNA PRIMARY CARE OF ALABAMA LLC

Provider Business Mailing Address
First Line	:	1621 GALLERIA BLVD
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4941 MONTEVALLO RD
Second Line	:
City	:	IRONDALE
State	:	AL
Zip	:	35210-2418
Country	:	US
Telephone Number	:	606-306-7706
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	STEPHEN M. NEE
Credential	:
Telephone Number	:	931-247-3202

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	03/11/2026

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