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Smith Dermatology, P.C.

Details

Name: Smith Dermatology, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 05 Oct 2007 (17 years ago)
Date of dissolution: 27 Dec 2017
Entity Number: 000-254-646
Register Number: 000254646
Place of Formation: Cullman County
Principal Address: CULLMAN, AL
Registered Office Street Address: 1705 MAIN AVE SW STE BCULLMAN, AL 35505
Authorized Capital: $10

Activities MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1770767337 2007-12-19 2007-12-27 1705 MAIN AVE SW, SUITE B, CULLMAN, AL, 350557206, US 1705 MAIN AVE SW, SUITE B, CULLMAN, AL, 350557206, US

Contacts
Phone +1 256-739-8260

Authorized person
Name DR. SCARLETTE D SMITH
Role OWNER
Phone 2567398260

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number 15896
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SMITH DERMATOLOGY, P. C. 401K PROFIT SHARING PLAN 2017 261189612 2018-07-31 SMITH DERMATOLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 2304 HIGHLAND CRESCENT SO, BIRMINGHAM, AL, 352052921
SMITH DERMATOLOGY, P.C. 401K PROFIT SHARING PLAN 2016 261189612 2017-07-24 SMITH DERMATOLOGY, P.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address PO BOX 1141, CULLMAN, AL, 350561141

Signature of
Role Plan administrator
Date 2017-07-24
Name of individual signing SCARLETTE D. SMITH
SMITH DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN 2016 261189612 2018-01-12 SMITH DERMATOLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 2304 HIGHLAND CRESCENT SOUTH, BIRMINGHAM, AL, 35205
SMITH DERMATOLOGY, P.C. 401K PROFIT SHARING PLAN 2015 261189612 2016-05-06 SMITH DERMATOLOGY, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207

Signature of
Role Plan administrator
Date 2016-05-06
Name of individual signing SCARLETTE D. SMITH
Role Employer/plan sponsor
Date 2016-05-06
Name of individual signing SCARLETTE D. SMITH
SMITH DERMATOLOGY, P.C. 401K PROFIT SHARING PLAN 2014 261189612 2015-06-17 SMITH DERMATOLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing SCARLETTE D. SMITH
Role Employer/plan sponsor
Date 2015-06-10
Name of individual signing SCARLETTE D. SMITH
SMITH DERMATOLOGY, P.C. 401K PROFIT SHARING PLAN 2013 261189612 2014-05-30 SMITH DERMATOLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207

Signature of
Role Plan administrator
Date 2014-05-30
Name of individual signing SCARLETTE D. SMITH
Role Employer/plan sponsor
Date 2014-05-30
Name of individual signing SCARLETTE D. SMITH
SMITH DERMATOLOGY, P.C. 401K PROFIT SHARING PLAN 2012 261189612 2013-07-17 SMITH DERMATOLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207

Signature of
Role Plan administrator
Date 2013-07-17
Name of individual signing SCARLETTE D. SMITH
Role Employer/plan sponsor
Date 2013-07-17
Name of individual signing SCARLETTE D. SMITH
SMITH DERMATOLOGY, P.C. 401K PROFIT SHARING PLAN 2011 261189612 2012-07-19 SMITH DERMATOLOGY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207

Plan administrator’s name and address
Administrator’s EIN 261189612
Plan administrator’s name SMITH DERMATOLOGY, P.C.
Plan administrator’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207
Administrator’s telephone number 2567398260

Signature of
Role Plan administrator
Date 2012-07-19
Name of individual signing SCARLETTE D. SMITH
Role Employer/plan sponsor
Date 2012-07-19
Name of individual signing SCARLETTE D. SMITH
SMITH DERMATOLOGY, P.C. 401K PROFIT SHARING PLAN 2010 261189612 2011-04-04 SMITH DERMATOLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207

Plan administrator’s name and address
Administrator’s EIN 261189612
Plan administrator’s name SMITH DERMATOLOGY, P.C.
Plan administrator’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207
Administrator’s telephone number 2567398260

Signature of
Role Plan administrator
Date 2011-04-03
Name of individual signing SCARLETTE D. SMITH
Role Employer/plan sponsor
Date 2011-04-03
Name of individual signing SCARLETTE D. SMITH
SMITH DERMATOLOGY, P.C. 401(K) PROFIT SHARING PLA 2009 261189612 2010-06-17 SMITH DERMATOLOGY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2567398260
Plan sponsor’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207

Plan administrator’s name and address
Administrator’s EIN 261189612
Plan administrator’s name SMITH DERMATOLOGY, P.C.
Plan administrator’s address 1705 MAIN AVENUE SW, SUITE B, CULLMAN, AL, 350557207
Administrator’s telephone number 2567398260

Signature of
Role Plan administrator
Date 2010-06-17
Name of individual signing SCARLETTE D. SMITH
Role Employer/plan sponsor
Date 2010-06-17
Name of individual signing SCARLETTE D. SMITH

Agent

Name Role Address
SMITH, SCARLETTE Agent 1720 KENSINGTON CIRCLE SWCULLMAN, AL 35055

Incorporator

Name Role Address
SMITH, SCARLETTE Incorporator 1720 KENSINGTON CIRCLE SWCULLMAN, AL 35055

Related by officers

SMITH, SCARLETTE

CaymaNich, LLC

Related by address

CULLMAN, AL

The A. A. A. Pest Control, Inc. Alabama Feed Service, Inc. Alabama Poultry Supply Co., Inc. Benefield Brothers, Incorporated Bennett Tire Service, Inc. Brindlee Mountain Development Corporation Buchmann Tire & Retreading, Inc. Builders & Traders, Inc. Central Grocery Company of Cullman Incorporated W. C. Chapman Poultry and Produce, Inc.

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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