| Name: | Lonnie N. Albin, M.D., Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 07 Oct 2003 (21 years ago) |
| Date of dissolution: | 15 Mar 2013 |
| Entity Number: | 000-231-336 |
| Register Number: | 000231336 |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Principal Address: | SCOTTSBORO, AL |
| Registered Office Street Address: | 913 S BROAD STSCOTTSBORO, AL 35768 |
| Registered Office Street Address ZIP Code: | 35768 |
| Authorized Capital: | $1,000 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699840827 | 2006-11-22 | 2012-04-20 | 507 HARLEY STREET, SCOTTSBORO, AL, 35768, US | 507 HARLEY STREET, SCOTTSBORO, AL, 35768, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-259-5550 |
| Fax | 2592565552 |
Authorized person
| Name | LONNIE N ALBIN |
| Role | PHYSICIAN/PRESIDENT |
| Phone | 2562595550 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 20176 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529918970 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051517783 |
| State | AL |
| Name | Role |
|---|---|
| ALBIN, LONNIE N | Agent |
| Name | Role |
|---|---|
| ALBIN, LONNIE N | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
