| Name: | Family Practice of Jacksonville, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 31 May 1978 (46 years ago) (Companies founded in May 1978) |
| Date of dissolution: | 14 Aug 2013 |
| Entity Number: | 000-051-462 |
| Register Number: | 000051462 |
| Place of Formation: | Calhoun County |
| Principal Address: | JACKSONVILLE, AL |
| Authorized Capital: | $2,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568571602 | 2006-08-30 | 2008-04-22 | PO BOX 777, 1881 HWY 21 SOUTH, JACKSONVILLE, AL, 36265, US | 1881 HWY 21 SOUTH, JACKSONVILLE, AL, 36265, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-435-3035 |
| Fax | 2564359111 |
Authorized person
| Name | KEWAL K VERMA |
| Role | PRESIDENT |
| Phone | 2564353035 |
Taxonomy
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | 7306 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 7306 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | CLIA |
| Number | 01D0689490 |
| Name | Role | Address |
|---|---|---|
| VERMA, KEWAL K | Incorporator | 525 STONEYBROOK DRIVEJACKSONVILLE, AL 36256 |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
