| Name: | Lakeland Physicians, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 Dec 2014 (10 years ago) |
| Entity Number: | 000-323-627 |
| Register Number: | 000323627 |
| County: | Montgomery |
| Place of Formation: | Tennessee |
| Principal Address: | 121 Leinart StClinton, TN 37716 |
| Registered Office Street Address: | 2527 College StMontgomery, AL 36106 |
| Registered Office Street Address ZIP Code: | 36106 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851780951 | 2015-01-13 | 2015-02-18 | 42030 HIGHWAY 195, STE A, HALEYVILLE, AL, 355657054, US | 42030 HIGHWAY 195, STE A, HALEYVILLE, AL, 355657054, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-485-7243 |
| Fax | 2054857244 |
Authorized person
| Name | STEVE CLAPP |
| Role | PRESIDENT |
| Phone | 2054857243 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 168737 |
| State | AL |
| Name | Role |
|---|---|
| Gewin, Murfee | Agent |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
