| Name: | South DeKalb Family Medical Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 01 Dec 1993 (31 years ago) (Companies founded in December 1993) |
| Date of dissolution: | 08 Aug 2023 |
| Entity Number: | 000-160-766 |
| Register Number: | 000160766 |
| ZIP code: | 35962 (Companies in De Kalb, 35962) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Principal Address: | CROSSVILLE, AL |
| Registered Office Street Address: | RT 3 BOX 11-BCROSSVILLE, AL 35962 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | ---- |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538487020 | 2010-05-10 | 2010-06-10 | 15239 AL HIGHWAY 68 W, CROSSVILLE, AL, 359620158, US | 15239 AL HWY 68 W, CROSSVILLE, AL, 359620158, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 256-528-7173 |
| Fax | 2565282425 |
Authorized person
| Name | JENNIE MILLER |
| Role | OFFICE MANAGER |
| Phone | 2565054532 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 541003854 |
| State | AL |
| Name | Role |
|---|---|
| UFFORD, RAYMOND C | Agent |
| Name | Role |
|---|---|
| UFFORD, RAYMOND C | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
