Search icon

JACKSON COUNTY FAMILY MEDICINE, LLC

Details

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)
Entity Number: 000-294-836
Register Number: 000294836
County: Jackson
Place of Formation: Jackson County
Registered Office Street Address: 126 E PEACHTREE STREETSCOTTSBORO, AL 35768
Registered Office Street Address ZIP Code: 35768

Activities TO PERFORM MEDICAL TREATMENT AND ALL INCIDENTALS RELATED THERETO

National Provider Identifier

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

Contacts

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

Agent

Name Role
LACKEY, GARY W Agent

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State