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Dothan Neurology Clinic, P.C.

Details

Name: Dothan Neurology Clinic, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 02 Jan 1986 (39 years ago)
Date of dissolution: 21 Nov 2019
Entity Number: 000-107-878
Register Number: 000107878
County: Houston
Place of Formation: Houston County
Registered Office Street Address: 3226 WEST MAIN ST SUITE 9DOTHAN, AL 36301
Registered Office Street Address ZIP Code: 36301
Authorized Capital: $1,200

Activities MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1003896887 2006-01-18 2020-08-22 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US

Contacts
Phone +1 334-793-9564
Fax 3346718907

Authorized person
Name MRS. LOIS W SALLAS
Role ADMINISTRATOR
Phone 3347939564

Taxonomy
Taxonomy Code 2084N0400X - Neurology Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2019 630917556 2020-07-23 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2018 630917556 2019-07-25 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2017 630917556 2018-06-29 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2016 630917556 2017-07-27 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2015 630917556 2016-07-28 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2014 630917556 2015-07-28 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2013 630917556 2014-07-23 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2012 630917556 2013-07-29 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301

Signature of
Role Plan administrator
Date 2013-07-25
Name of individual signing DAVID ALAN DAVIS
DOTHAN NEUROLOGY CLINIC, P.C. PROFIT SHARING PLAN 2011 630917556 2012-07-16 DOTHAN NEUROLOGY CLINIC, P.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301

Plan administrator’s name and address
Administrator’s EIN 630917556
Plan administrator’s name DOTHAN NEUROLOGY CLINIC, P.C.
Plan administrator’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
Administrator’s telephone number 3347939564

Signature of
Role Plan administrator
Date 2012-07-04
Name of individual signing DAVID ALAN DAVIS

Incorporator

Name Role
DAVIS, DAVID ALAN MD Incorporator
THOMPSON, BRIAN MARSHALL MD Incorporator

Agent

Name Role
DAVIS, DAVID ALAN MD Agent

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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