Healthcare Provider Details

I. General information

NPI: 1477399111
Provider Name (Legal Business Name): UROGYNECOLOGY OF EAST ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 N DEAN RD STE 300
AUBURN AL
36830-9452
US

IV. Provider business mailing address

890 N DEAN RD STE 300
AUBURN AL
36830-9452
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-5970
  • Fax: 334-528-5971
Mailing address:
  • Phone: 334-528-5970
  • Fax: 334-528-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL A PRICE JR.
Title or Position: CFO
Credential:
Phone: 334-528-1310