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Southeastern Pediatric Associates, P.A.

Details

Name: Southeastern Pediatric Associates, P.A.
Jurisdiction: Alabama
Legal type: Domestic Professional Association
Status: Exists
Date of registration: 06 Mar 1978 (47 years ago)
Entity Number: 000-050-161
Register Number: 000050161
County: Houston
Place of Formation: Houston County
Principal Address: 364 HONEYSUCKLE RDDOTHAN, AL 36305
Principal Address ZIP Code: 36305

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1093907412 2007-08-10 2011-01-12 364 HONEYSUCKLE RD, DOTHAN, AL, 363051140, US 364 HONEYSUCKLE RD, DOTHAN, AL, 363051140, US

Contacts
Phone +1 334-794-8656
Fax 3377027047

Authorized person
Name MRS. S. LUCY EVERETT
Role OFFICE MANAGER
Phone 3347948656

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 272658100
State FL
Issuer MEDICAID
Number 528300110
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2023 630738893 2024-03-05 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2024-03-05
Name of individual signing CRAIG B. ADAMS
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2022 630738893 2023-09-29 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2023-09-29
Name of individual signing CRAIG B. ADAMS
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2021 630738893 2022-07-26 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2022-07-26
Name of individual signing CRAIG B. ADAMS
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2020 630738893 2021-05-26 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2021-05-26
Name of individual signing CRAIG B. ADAMS, MD
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2019 630738893 2020-06-01 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2020-06-01
Name of individual signing CRAIG B. ADAMS, MD
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2018 630738893 2019-06-13 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2019-06-13
Name of individual signing CRAIG B. ADAMS, MD
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2017 630738893 2018-07-11 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2018-07-11
Name of individual signing CRAIG B. ADAMS, MD
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2016 630738893 2017-04-04 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2017-04-04
Name of individual signing CRAIG B. ADAMS, MD
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2015 630738893 2016-07-01 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2016-07-01
Name of individual signing CRAIG B. ADAMS, MD
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2014 630738893 2015-07-18 SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-02-01
Business code 621111
Sponsor’s telephone number 3347948656
Plan sponsor’s address 364 HONEYSUCKLE ROAD, DOTHAN, AL, 36305

Signature of
Role Plan administrator
Date 2015-07-18
Name of individual signing CRAIG B. ADAMS, MD

Member

Name Role Address
GERMANSON, SARAH Member 364 HONEYSUCKLE RDDOTHAN, AL 36305
MORRIS, LAUREN Member 364 HONEYSUCKLE RDDOTHAN, AL 36305
CARPENTER, DARRELL Member 364 HONEYSUCKLE RDDOTHAN, AL 36305
ADAMS, CRAIG Member 364 HONEYSUCKLE RDDOTHAN, AL 36305
GATLIN, RISHA K Member 364 HONEYSUCKLE RDDOTHAN, AL 36305
BLAXTON, ANGELA Member 364 HONEYSUCKLE ROADDOTHAN, AL 36305

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Related by address

364 HONEYSUCKLE RDDOTHAN, AL 36305

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Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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