| Name: | Decatur Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 20 Nov 1998 (26 years ago) |
| Entity Number: | 000-199-175 |
| Register Number: | 000199175 |
| County: | Morgan |
| Place of Formation: | Morgan County |
| Principal Address: | DECATUR, AL |
| Registered Office Street Address: | 3205 MANASSAS RUN SWDECATUR, AL 35603 |
| Registered Office Street Address ZIP Code: | 35603 |
| Authorized Capital: | $500 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982805149 | 2007-05-29 | 2009-11-20 | 1215 7TH STREET SE, SUITE 110, DECATUR, AL, 356013381, US | 1215 7TH STREET SE, SUITE 110, DECATUR, AL, 356013381, US | |||||||||||||||||||||
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| Phone | +1 256-306-1655 |
| Fax | 2563061601 |
Authorized person
| Name | MICHELLE DRAKE RADCLIFF |
| Role | OFFICE MANAGER |
| Phone | 2565848211 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529902310 |
| State | AL |
| Name | Role |
|---|---|
| DONHAM, MICHAEL C | Agent |
| Name | Role |
|---|---|
| DONHAM, MICHAEL C | Incorporator |
| HARBIN, STEPHEN W | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
