| Name: | Southeast Medical Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Sep 2017 (7 years ago) |
| Entity Number: | 000-403-746 |
| Register Number: | 000403746 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 13529 SHARPES LAKE ROADNORTHPORT, AL 35473 |
| Registered Office Street Address ZIP Code: | 35473 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871059212 | 2019-02-11 | 2019-02-11 | 1930 EDWARDS LAKE RD STE 138, BIRMINGHAM, AL, 352353720, US | 1930 EDWARDS LAKE RD STE 138B, BIRMINGHAM, AL, 352353720, US | |||||||||||||||||
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| Phone | +1 205-534-5114 |
| Fax | 2052786939 |
| Phone | +1 205-308-3183 |
Authorized person
| Name | DOUG RANDALL |
| Role | MANAGING MEMBER |
| Phone | 2053083183 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| RANDALL, DOUGLAS | Agent |
| Name | Role | Address |
|---|---|---|
| MILLER, MARTHA LEGG | Organizer | 1901 6TH AVENUE NORTH SUITE 1500BIRMINGHAM, AL 35203 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
