Healthcare Provider Details

I. General information

NPI: 1205777604
Provider Name (Legal Business Name): EAST ALABAMA COMMUNITY PRENATAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 48TH ST
VALLEY AL
36854-3666
US

IV. Provider business mailing address

2000 PEPPERELL PKWY
OPELIKA AL
36801-5452
US

V. Phone/Fax

Practice location:
  • Phone: 334-710-0091
  • Fax:
Mailing address:
  • Phone: 334-710-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

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