| Name: | General Surgery Associates of Dothan, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 06 May 1997 (27 years ago) |
| Date of dissolution: | 29 Dec 2016 |
| Entity Number: | 000-187-282 |
| Register Number: | 000187282 |
| Historical Names: |
Carpenter General Surgery, P.C.
|
| County: | Houston |
| Place of Formation: | Houston County |
| Principal Address: | DOTHAN, AL 36301 |
| Principal Address ZIP Code: | 36301 |
| Registered Office Street Address: | 2389 WEST MAIN STREETDOTHAN, AL 36301 |
| Registered Office Street Address ZIP Code: | 36301 |
| Authorized Capital: | $1,200 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700866233 | 2006-01-19 | 2013-09-03 | 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US | 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US | |||||||||||||||||||||||||
|
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| Phone | +1 334-793-9564 |
| Fax | 3346718907 |
Authorized person
| Name | CHARLES J CARPENTER JR. |
| Role | OWNER/PRESIDEN |
| Phone | 3347939564 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | 17006 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529703840 |
| State | AL |
| Name | Role |
|---|---|
| CARPENTER, CHARLES J JR | Agent |
| Name | Role | Address |
|---|---|---|
| MCNAB, F MITCH | Incorporator | 200 PARKWEST CIRCLE SUITE 2DOTHAN, AL 36303 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2001-06-26 | Name Change | Carpenter General Surgery, P.C. | General Surgery Associates of Dothan, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
