Catoma Dermatology, LLC

Contacts

Phone	+1 256-737-7546
Fax	2567365848
Fax	2568416180

Authorized person

Name	CLANCY H JOHNSON
Role	PHYSICIAN
Phone	2567377546

Taxonomy

Taxonomy Code	207N00000X - Dermatology Physician
License Number	27325
State	AL
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2024-07-09
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2023-06-15
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2022-07-14
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2021-09-30
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2020-09-10
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2019-07-28
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2018-07-10
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2017-07-17
Name of individual signing	CLANCY JOHNSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	2567377546
Plan sponsor’s address	1300 BRIDGE CREEK DRIVE NE, SUITE A, CULLMAN, AL, 35055

Signature of

Role	Plan administrator
Date	2016-05-16
Name of individual signing	CLANCY JOHNSON