| Name: | Jeffery G. Parker, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 16 Feb 1999 (26 years ago) |
| Entity Number: | 000-200-957 |
| Register Number: | 000200957 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 2900 MANCHESTER CIRCLETUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $5,000 |
Activities
RENDER PROFESSIONAL MEDICAL SERVICES TO THE PUBLIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205997285 | 2006-12-13 | 2016-03-28 | 2810 LURLEEN WALLACE BOULEVARD, NORTHPORT, AL, 35476, US | 2810 LURLEEN WALLACE BOULEVARD, NORTHPORT, AL, 35476, US | |||||||||||||||||||||||||||
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| Phone | +1 205-333-7670 |
| Fax | 2053333161 |
Authorized person
| Name | DR. JEFFERY G PARKER |
| Role | PHYSICIAN OWNER |
| Phone | 2053337670 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE RAILROAD |
| Number | DO3780 |
| State | AL |
| Issuer | MEDICAID |
| Number | 104124 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PARKER, JEFFERY G | Agent | 5081 YORKSHIRE LNTUSCALOOSA, AL 35406 |
| Name | Role | Address |
|---|---|---|
| PARKER, JEFFERY G | Incorporator | 5081 YORKSHIRE LNTUSCALOOSA, AL 35406 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
