| Name: | Whitesburg Family Medicine, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 May 2008 (16 years ago) |
| Entity Number: | 000-420-717 |
| Register Number: | 000420717 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 4704 WHITESBURG DR SE STE 201HUNTSVILLE, AL 35802 |
| Registered Office Street Address ZIP Code: | 35802 |
Activities
MANAGEMENT/CONSULTING SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568620060 | 2008-05-30 | 2012-01-16 | 4800 WHITESPORT CIR SW STE 1, STE. 201, HUNTSVILLE, AL, 358016444, US | 4800 WHITESPORT CIR SW STE 1, STE. 201, HUNTSVILLE, AL, 358016444, US | |||||||||||||||||||||||||||
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| Phone | +1 256-327-0888 |
| Fax | 2563270891 |
Authorized person
| Name | DR. ELISA J HALEY |
| Role | PRESIDENT |
| Phone | 2563270888 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 27081 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 27651 |
| State | AL |
| Is Primary | No |
| Name | Role |
|---|---|
| ELISA J HALEY MD PC | Member |
| DAVID A MCMILLION MD PC | Member |
| Name | Role |
|---|---|
| HALEY, ELISA J | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
