Provider Demographics
NPI:1285761353
Name:EAST ALABAMA INTERNAL MEDICINE,PC
Entity type:Organization
Organization Name:EAST ALABAMA INTERNAL MEDICINE,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-749-4724
Mailing Address - Street 1:1995 PEPPERELL PKWY
Mailing Address - Street 2:SUITE #3
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5460
Mailing Address - Country:US
Mailing Address - Phone:334-749-4724
Mailing Address - Fax:334-749-7003
Practice Address - Street 1:1995 PEPPERELL PKWY
Practice Address - Street 2:SUITE #3
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5460
Practice Address - Country:US
Practice Address - Phone:334-749-4724
Practice Address - Fax:334-749-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty