Provider Demographics
NPI:1770766339
Name:EAST ALABAMA MEDICAL&GI CLINIC LLC
Entity type:Organization
Organization Name:EAST ALABAMA MEDICAL&GI CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PREMEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KAMATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-749-2007
Mailing Address - Street 1:2112 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6042
Mailing Address - Country:US
Mailing Address - Phone:334-749-2007
Mailing Address - Fax:334-749-6007
Practice Address - Street 1:2112 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6042
Practice Address - Country:US
Practice Address - Phone:334-749-2007
Practice Address - Fax:334-749-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty