| Name: | Grayson Valley Family Health Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 10 Dec 2014 (10 years ago) |
| Date of dissolution: | 27 Sep 2017 |
| Entity Number: | 000-324-161 |
| Register Number: | 000324161 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 5577 CHALKVILLE ROADBIRMINGHAM, AL 35235 |
| Registered Office Street Address ZIP Code: | 35235 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053719567 | 2014-12-15 | 2015-01-13 | 5577 CHALKVILLE RD, BIRMINGHAM, AL, 352352171, US | 5577 CHALKVILLE RD, BIRMINGHAM, AL, 352352171, US | |||||||||||||||||||
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| Phone | +1 205-853-3533 |
| Fax | 2058563808 |
Authorized person
| Name | MRS. STACY ANN DAVIS |
| Role | CRNP |
| Phone | 2058533533 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 1-137379 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DAVIS, JOHN J | Agent | 11225 COLLEGE BLVD., STE 302 OVERLAOVERLAND PARK, KS 66210 |
| Name | Role | Address |
|---|---|---|
| DAVIS, STACY ANN | Organizer | 5577 CHALKVILLE ROADBIRMINGHAM, AL 35235 |
| DAVIS, JOHN J | Organizer | 11225 COLLEGE BLVD., STE 302 OVERLAOVERLAND PARK, KS 66210 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
