| Name: | Northwest Alabama Psychiatric Services, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 16 May 1994 (30 years ago) |
| Entity Number: | 000-164-213 |
| Register Number: | 000164213 |
| County: | Walker |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 4330 MEDICAL PLAZA EAST STE 106JASPER, AL 35501 |
| Registered Office Street Address ZIP Code: | 35501 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
ENGAGE IN PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306448394 | 2020-11-13 | 2022-03-07 | 20 MEDICAL CENTER DR STE 300, JASPER, AL, 355013428, US | 20 MEDICAL CENTER DR STE 300, JASPER, AL, 355013428, US | |||||||||||||||
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| Phone | +1 205-384-0141 |
| Fax | 2053840171 |
Authorized person
| Name | TERRY WAYNE BENTLEY |
| Role | OWNER/PSYCHIATRIST |
| Phone | 2053840141 |
Taxonomy
| Taxonomy Code | 2084B0040X - Behavioral Neurology & Neuropsychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SMITH, RALPH H II | Incorporator | 1819 5TH AVENUE NORTH SUITE 1100BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| BENTLEY, TERRY W MD | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
