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) (Companies founded in February 1999) |
Entity Number: | 000-200-957 |
Register Number: | 000200957 |
ZIP code: | 35406 (Companies in Tuscaloosa, 35406) |
County: | Tuscaloosa |
Place of Formation: | Tuscaloosa County |
Principal Address: | TUSCALOOSA, AL |
Registered Office Street Address: | 2900 MANCHESTER CIRCLETUSCALOOSA, AL 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 | |||||||||||||||||||||||||||
|
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