Healthcare Provider Details

I. General information

NPI: 1699761106
Provider Name (Legal Business Name): GREGORY D PRICE SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MEDICAL PARK DR STE 1
ANDALUSIA AL
36420-5355
US

IV. Provider business mailing address

215 MEDICAL PARK DR STE 1
ANDALUSIA AL
36420-5355
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-4327
  • Fax: 334-222-4333
Mailing address:
  • Phone: 334-222-4327
  • Fax: 334-222-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1846890-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14470
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: