Healthcare Provider Details

I. General information

NPI: 1477040483
Provider Name (Legal Business Name): PRICE FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAIN ST
WATERLOO AL
35677-4401
US

IV. Provider business mailing address

314 MAIN ST
WATERLOO AL
35677-4401
US

V. Phone/Fax

Practice location:
  • Phone: 256-629-0033
  • Fax: 256-629-0042
Mailing address:
  • Phone: 256-629-0033
  • Fax: 256-629-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-01128
License Number StateAL

VIII. Authorized Official

Name: MRS. AMANDA DIANE PRICE
Title or Position: OWNER
Credential: CRNP
Phone: 256-629-0033