| Name: | Azalea Physicians for Women, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 14 Apr 2004 (21 years ago) (Companies founded in April 2004) |
| Entity Number: | 000-234-700 |
| Register Number: | 000234700 |
| ZIP code: | 36360 (Companies in Dale, 36360) |
| County: | Dale |
| Place of Formation: | Dale County |
| Principal Address: | OZARK, AL |
| Registered Office Street Address: | 1864 E ANDREWS AVEOZARK, AL 36360 |
| Authorized Capital: | $1,200 |
Activities
OBSTETRICS/GYNECOLOGY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356490627 | 2007-01-09 | 2008-05-30 | 2126 W ROY PARKER RD, SUITE 204, OZARK, AL, 363608566, US | 2126 W ROY PARKER RD, SUITE 204, OZARK, AL, 363608566, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-445-1025 |
| Fax | 3344451026 |
Authorized person
| Name | DR. DAVID P DULANEY |
| Role | PHYSICIAN |
| Phone | 3344451025 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| License Number | 00023709 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| License Number | 00026094 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529919790 |
| State | AL |
| Name | Role |
|---|---|
| MCNAB, W MIACH | Agent |
| Name | Role |
|---|---|
| DULANEY, DAVID P | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
