| Name: | Harrelson Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 10 Jul 2001 (23 years ago) |
| Entity Number: | 000-217-666 |
| Register Number: | 000217666 |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | OPELIKA, AL |
| Registered Office Street Address: | 2112 EXECUTIVE PARK DROPELIKA, AL 36801 |
| Registered Office Street Address ZIP Code: | 36801 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $5,000 |
Activities
PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619165693 | 2007-10-04 | 2012-06-12 | 1559 PROFESSIONAL PKWY, AUBURN, AL, 368302858, US | 1559 PROFESSIONAL PKWY, AUBURN, AL, 368302858, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-826-1121 |
| Fax | 3348261149 |
Authorized person
| Name | DR. GARY HARRELSON |
| Role | DOCTOR |
| Phone | 3348261121 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 11448 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529913570 |
| State | AL |
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 051503715 |
| State | AL |
| Issuer | BLUE CROSS |
| Number | 51503715 |
| State | AL |
| Name | Role |
|---|---|
| HARRELSON, GARY B | Agent |
| Name | Role |
|---|---|
| HARRELSON, GARY B | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
