| Name: | J. Randall Pitts, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 Dec 1983 (41 years ago) |
| Entity Number: | 000-095-285 |
| Register Number: | 000095285 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 3300 CAHABA ROAD STE 100 SHADES BROOK OFFICE BLDGBIRMINGHAM, AL 35223 |
| Registered Office Street Address ZIP Code: | 35223 |
| Authorized Capital: | $1,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164501466 | 2006-11-06 | 2016-11-03 | 109 MEDICAL CENTER DR, CLANTON, AL, 350452331, US | 109 MEDICAL CENTER DR, CLANTON, AL, 350452331, US | |||||||||||||||||||||||||
|
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| Phone | +1 205-755-2296 |
| Fax | 2057559378 |
Authorized person
| Name | JAMES RANDALL PITTS |
| Role | PRESIDENT |
| Phone | 2057552296 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | 5420 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000005038 |
| State | AL |
| Name | Role |
|---|---|
| PITTS, J RANDALL MD | Agent |
| Name | Role |
|---|---|
| PITTS, J RANDALL MD | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
