| Name: | Eastern Shore Developmental Clinic L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 15 Apr 2013 (12 years ago) |
| Entity Number: | 000-278-530 |
| Register Number: | 000278530 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | 26420 KENSINGTON PLACEDAPNE, AL 36526 |
| Principal Address ZIP Code: | 36526 |
| Principal Mailing Address: | PO BOX 1544FAIRHOPE, AL 36533 |
| Principal Mailing Address ZIP Code: | 36533 |
| Registered Office Street Address: | 2 N JACKSON ST STE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
PRIMARY CARE PEDIATRIC DEVELOPMENTAL CLINIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023455953 | 2013-06-02 | 2013-06-02 | 26420 KENSINGTON PL STE A, DAPHNE, AL, 365265123, US | 26420 KENSINGTON PL STE A, DAPHNE, AL, 365265123, US | |||||||||||||||||||||||||
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| Phone | +1 251-625-0400 |
Authorized person
| Name | DR. WARNER MERRILL WIGGINS |
| Role | OFFICAL |
| Phone | 2514025589 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 00008950 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| License Number | 1076812 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| VCORP AGENT SERVICES INC | Agent |
| Name | Role | Address |
|---|---|---|
| WIGGINS, JULIE | Organizer | 27 PIER AVEFAIRHOPE, AL 36532 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
