Name: | Mallette Dermatology, P.C. |
Jurisdiction: | Alabama |
Legal type: | Domestic Professional Corporation |
Status: | Exists |
Date of registration: | 28 May 2004 (20 years ago) |
Entity Number: | 000-235-659 |
Register Number: | 000235659 |
County: | Limestone |
Place of Formation: | Limestone County |
Principal Address: | ATHENS, AL |
Registered Office Street Address: | 213 S HOUSTON STATHENS, AL 35611 |
Registered Office Street Address ZIP Code: | 35611 |
Authorized Capital: | $5,000 |
Paid Share Capital: | $1,000 |
Activities
MEDICAL SERVICES PRACTICE
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1265636955 | 2007-06-14 | 2008-04-20 | 707 HWY 31 S, SUITE F, ATHENS, AL, 35611, US | 707 HWY 31 S, SUITE F, ATHENS, AL, 35611, US | |||||||||||||||||||
|
Phone | +1 256-771-1995 |
Fax | 2567711965 |
Authorized person
Name | STEPHEN G MALLETTE |
Role | OWNER PHYSICIAN |
Phone | 2567711995 |
Taxonomy
Taxonomy Code | 174400000X - Specialist |
License Number | DO841 |
State | AL |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
MALLETTE, STEPHEN G | Agent | 22234 NICK DAVIS ROADATHENS, AL 35613 |
Name | Role | Address |
---|---|---|
MALLETTE, STEPHEN G | Incorporator | 22234 NICK DAVIS ROADATHENS, AL 35613 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State