Organization
EAST ALABAMA FAMILY PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH LYLE FULLER D.O. (PRESIDENT)
(334) 741-0075
Entity
Organization
Contact information
Practice address
2214 GATEWAY DR, SUITE C, OPELIKA, AL 36801-1500
(334) 741-0075
(334) 741-4075
Mailing address
2214 GATEWAY DR, SUITE C, OPELIKA, AL 36801-1500
(334) 741-0075
(334) 741-4075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO-350
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529602340
—
AL
Enumeration date
11/21/2006
Last updated
12/22/2022
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