Healthcare Provider Details
I. General information
NPI: 1598935637
Provider Name (Legal Business Name): EAMC PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/05/2008
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2000 PEPPERELL PKWY
OPELIKA AL
36801-5452
US
IV. Provider business mailing address
2000 PEPPERELL PARKWAY
OPELIKA AL
36801-5452
US
V. Phone/Fax
- Phone: 334-528-1275
- Fax: 334-528-1547
- Phone: 334-528-1275
- Fax: 334-528-1547
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
SAMUEL
A
PRICE
JR.
Title or Position: CFO
Credential:
Phone: 334-528-1310