| Name: | Family Health and Wellness Center LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Mar 2014 (11 years ago) |
| Entity Number: | 000-299-898 |
| Register Number: | 000299898 |
| County: | Calhoun |
| Place of Formation: | Calhoun County |
| Principal Address: | 547 YORK IMPERIAL TRAILOXFORD, AL 36203 |
| Principal Address ZIP Code: | 36203 |
Activities
PROVIDE HEALTHCARE AND OTHER ANCILLARY RELATED SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407263650 | 2014-07-21 | 2015-04-13 | 671 SNOW ST, OXFORD, AL, 362031212, US | 671 SNOW ST, OXFORD, AL, 362031212, US | |||||||||||||||||||||||
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| Phone | +1 256-454-8620 |
Authorized person
| Name | DAVISSON EDMOND |
| Role | OWNER |
| Phone | 2564548620 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD30459 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 141772 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| EDMOND, SUSAN MARIE MASHBURN | Organizer | 547 YORK IMPERIAL TRAILOXFORD, AL 36203 |
| EDMOND, DAVISSON J | Organizer | 547 YORK IMPERIAL TRAILOXFORD, AL 36203 |
| EDMOND, SUSAN MARIE | Organizer | 547 YORK IMPERIAL TRAILOXFORD, AL 36203 |
| Name | Role | Address |
|---|---|---|
| EDMOND, DAVISSON J | Agent | 547 YORK IMPERIAL TRAILOXFORD, AL 36203 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
