| Name: | Dothan Psychiatric, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 20 Nov 2000 (24 years ago) |
| Date of dissolution: | 21 Feb 2018 |
| Entity Number: | 000-213-369 |
| Register Number: | 000213369 |
| County: | Houston |
| Place of Formation: | Houston County |
| Principal Address: | DOTHAN, AL |
| Registered Office Street Address: | STE 501 1118 ROSS CLARK CIRCLEDOTHAN, AL 36301 |
| Registered Office Street Address ZIP Code: | 36301 |
| Authorized Capital: | $1,200 |
Activities
MEDICAL SPECIALTY OF PSYCHIATRIC MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053391581 | 2006-01-19 | 2008-08-25 | 256 HONEYSUCKLE RD, SUITE 2, DOTHAN, AL, 363051157, US | 256 HONEYSUCKLE RD, SUITE 2, DOTHAN, AL, 363051157, US | |||||||||||||||||||||
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| Phone | +1 334-702-8425 |
| Fax | 3347948460 |
Authorized person
| Name | MS. GISELA S DREW |
| Role | ADMINISTRATOR |
| Phone | 3347028425 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529907650 |
| State | AL |
| Name | Role |
|---|---|
| HICKS, C ROBY JR | Agent |
| Name | Role |
|---|---|
| HICKS, C ROBY JR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
