| Name: | Gillis L. Payne, Jr., M.D. P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 02 Aug 1976 (48 years ago) (Companies founded in August 1976) |
| Date of dissolution: | 06 Jan 2023 |
| Entity Number: | 000-045-463 |
| Register Number: | 000045463 |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Authorized Capital: | $10,000 |
| Paid Share Capital: | $2,000 |
Activities
PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942536867 | 2009-10-28 | 2011-04-19 | 7006 FULTON COURT, MONTGOMERY, AL, 36117, US | 7006 FULTON COURT, MONTGOMERY, AL, 36117, US | |||||||||||||||||||||||||||
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| Phone | +1 334-244-7209 |
| Fax | 3342446604 |
Authorized person
| Name | DR. GILLIS L. PAYNE JR. |
| Role | PHYSICIAN/OWNER |
| Phone | 3342447209 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51004903 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000004903 |
| State | AL |
| Name | Role |
|---|---|
| PAYNE, GILLIS L | Incorporator |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
