| Name: | JACKSON COUNTY FAMILY MEDICINE, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Jan 2014 (11 years ago) (Companies founded in January 2014) |
| Entity Number: | 000-294-836 |
| Register Number: | 000294836 |
| ZIP code: | 35768 (Companies in Jackson, 35768) |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Registered Office Street Address: | 126 E PEACHTREE STREETSCOTTSBORO, AL 35768 |
Activities
TO PERFORM MEDICAL TREATMENT AND ALL INCIDENTALS RELATED THERETO
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366868531 | 2014-03-12 | 2020-04-14 | 508 HARLEY ST, STE C, SCOTTSBORO, AL, 357684294, US | 508 HARLEY ST, STE C, SCOTTSBORO, AL, 357684294, US | |||||||||||||||||||
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| Phone | +1 256-259-5537 |
| Fax | 2562593189 |
Authorized person
| Name | DR. WILLIAM HARDIN COLEMAN JR. |
| Role | PRESIDENT |
| Phone | 2562595537 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 19311 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| LACKEY, GARY W | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
