| 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 | |||||||||||||||||||
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| 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
