Healthcare Provider Details

I. General information

NPI: 1053264135
Provider Name (Legal Business Name): ERIC PRICE II ATC, LSAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NOTTINGHAM WAY
ALBANY GA
31707-6677
US

IV. Provider business mailing address

167 LAURELBROOK DR
LEESBURG GA
31763-4925
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-1301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: