| Name: | Wilburn A. Smith, Jr., M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 17 Feb 1999 (26 years ago) |
| Entity Number: | 000-201-211 |
| Register Number: | 000201211 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2023 NORMANDIE DRIVEMONTGOMERY, AL 36111 |
| Registered Office Street Address ZIP Code: | 36111 |
| Authorized Capital: | $10 |
Activities
PRACTICE OF MEDICINE/ORTHOPEDICS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477733269 | 2007-11-08 | 2011-12-01 | 4131 CARMICHAEL RD, SUITE 28, MONTGOMERY, AL, 361062801, US | 4131 CARMICHAEL RD, SUITE 28, MONTGOMERY, AL, 361062801, US | |||||||||||||||||||||||||
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| Phone | +1 334-281-6363 |
| Fax | 3342844253 |
Authorized person
| Name | LAURA H SMITH |
| Role | MANAGER/NURSE PRACTITIONER |
| Phone | 3342816363 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | 9125 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000083838 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SMITH, WILBURN A JR | Incorporator | 1100 EAST PLEASANT GROVE ROADMONTGOMERY, AL 36105 |
| Name | Role | Address |
|---|---|---|
| SMITH, WILBURN A JR | Agent | 1100 EAST PLEASANT GROVE ROADMONTGOMERY, AL 36105 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
