| Name: | Brookwood Medical Group, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 01 May 1978 (47 years ago) |
| Date of dissolution: | 29 Dec 2016 |
| Entity Number: | 000-051-432 |
| Register Number: | 000051432 |
| Historical Names: |
Brookwood Medical Group, P.A.
|
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2018 BROOKWOOD MED CTR DRBIRMINGHAM, AL 35209 |
| Registered Office Street Address ZIP Code: | 35209 |
| Authorized Capital: | $10,000 |
| Paid Share Capital: | $1,002 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891837936 | 2007-02-13 | 2020-08-22 | 2018 BROOKWOOD MEDICAL CTR DR, SUITE G-5 PROFESSIONAL BUILDING, BIRMINGHAM, AL, 352096898, US | 2018 BROOKWOOD MEDICAL CTR DR, SUITE G-5 PROFESSIONAL BUILDING, BIRMINGHAM, AL, 352096898, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 205-877-2900 |
| Fax | 2058772904 |
Authorized person
| Name | LINDA ROBERTS YOUNG |
| Role | OFFICE MANAGER |
| Phone | 2058772900 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 3558 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 8361 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 15045 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 24915 |
| State | AL |
| Is Primary | No |
| Name | Role |
|---|---|
| BLANTON, JAMES H MD | Agent |
| Name | Role |
|---|---|
| BLANTON, JAMES H MD | Incorporator |
| BROWNE, CRAIG MD | Incorporator |
| NICHOLSON, JAMES MD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1984-05-01 | Name Change | Brookwood Medical Group, P.A. | Brookwood Medical Group, P.C. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
