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Davis Family Medicine, P.C.

Details

Name: Davis Family Medicine, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 18 Dec 2000 (24 years ago)
Entity Number: 000-213-726
Register Number: 000213726
County: Dallas
Place of Formation: Dallas County
Principal Address: SELMA, AL
Registered Office Street Address: 222 DALLAS AVESELMA, AL 36701
Registered Office Street Address ZIP Code: 36701
Authorized Capital: $1,000

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1427238997 2007-11-13 2020-12-01 223 DALLAS AVE, SELMA, AL, 367015744, US 223 DALLAS AVE, SELMA, AL, 367015744, US

Contacts
Phone +1 334-874-0017
Fax 3348726563

Authorized person
Name DR. GLENTON W DAVIS SR.
Role OWNER
Phone 3348740017

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 14309
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN 2023 631263603 2024-09-25 DAVIS FAMILY MEDICINE 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701

Signature of
Role Plan administrator
Date 2024-09-25
Name of individual signing GLENTON DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-25
Name of individual signing GLENTON DAVIS
Valid signature Filed with authorized/valid electronic signature
DAVIS FAMILY MEDICINE CASH BALANCE PLAN 2023 631263603 2024-04-05 DAVIS FAMILY MEDICINE 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701
DAVIS FAMILY MEDICINE CASH BALANCE PLAN 2022 631263603 2023-06-05 DAVIS FAMILY MEDICINE 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN 2022 631263603 2023-10-02 DAVIS FAMILY MEDICINE 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701

Signature of
Role Plan administrator
Date 2023-10-02
Name of individual signing GLENTON DAVIS
Role Employer/plan sponsor
Date 2023-10-02
Name of individual signing GLENTON DAVIS
DAVIS FAMILY MEDICINE CASH BALANCE PLAN 2021 631263603 2022-09-22 DAVIS FAMILY MEDICINE 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN 2021 631263603 2022-09-14 DAVIS FAMILY MEDICINE 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701

Signature of
Role Plan administrator
Date 2022-09-14
Name of individual signing GLENTON DAVIS
Role Employer/plan sponsor
Date 2022-09-14
Name of individual signing GLENTON DAVIS
DAVIS FAMILY MEDICINE CASH BALANCE PLAN 2020 631263603 2021-04-30 DAVIS FAMILY MEDICINE 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN 2020 631263603 2021-10-01 DAVIS FAMILY MEDICINE 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701

Signature of
Role Plan administrator
Date 2021-10-01
Name of individual signing GLENTON DAVIS
Role Employer/plan sponsor
Date 2021-10-01
Name of individual signing GLENTON DAVIS
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN 2019 631263603 2020-10-13 DAVIS FAMILY MEDICINE 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701

Signature of
Role Plan administrator
Date 2020-10-13
Name of individual signing GLENTON DAVIS
Role Employer/plan sponsor
Date 2020-10-13
Name of individual signing GLENTON DAVIS
DAVIS FAMILY MEDICINE CASH BALANCE PLAN 2019 631263603 2020-04-24 DAVIS FAMILY MEDICINE 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3348740017
Plan sponsor’s address 223 DALLAS AVE., SELMA, AL, 36701

Agent

Name Role Address
DAVIS, GLENTON W Agent 223 DALLAS AVENUESELMA, AL 36701

Incorporator

Name Role Address
DAVIS, GLENTON W Incorporator 223 DALLAS AVENUESELMA, AL 36701

Related by officers

DAVIS, GLENTON W

DALLAS IPA, LLC

Related by address

SELMA, AL

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Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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