| Name: | Gastroenterology Associates of Dothan, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 01 Jul 1986 (38 years ago) (Companies founded in July 1986) |
| Date of dissolution: | 29 Oct 2009 |
| Entity Number: | 000-111-394 |
| Register Number: | 000111394 |
| ZIP code: | 36303 (Companies in Houston, 36303) |
| County: | Houston |
| Place of Formation: | Houston County |
| Principal Address: | DOTHAN, AL |
| Registered Office Street Address: | 3226 WEST MAIN STREET SUITE 9DOTHAN, AL 36303 |
| Authorized Capital: | $1,200 |
Activities
GASTROENTEROLOGY SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407913437 | 2007-01-02 | 2020-08-22 | 480 HONEYSUCKLE RD, DOTHAN, AL, 363051156, US | 480 HONEYSUCKLE RD, DOTHAN, AL, 363051156, US | |||||||||||||||||||||
|
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| Phone | +1 334-836-1212 |
| Fax | 3348361888 |
Authorized person
| Name | NICK GWIN |
| Role | ADMINISTRATOR |
| Phone | 3348361212 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE GROUP PAYEE |
| Number | E427 |
| State | AL |
| Name | Role |
|---|---|
| JACKSON, DANIEL FORREST MD | Agent |
| Name | Role |
|---|---|
| JACKSON, DANIEL FORREST MD | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
