| Name: | Jackson Family Practice LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 30 Dec 2009 (15 years ago) |
| Entity Number: | 000-441-534 |
| Register Number: | 000441534 |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Principal Address: | SCOTTSBORO, AL |
| Registered Office Street Address: | 506 HARLEY STSCOTTSBORO, AL 35768 |
| Registered Office Street Address ZIP Code: | 35768 |
Activities
MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982935532 | 2010-01-21 | 2010-01-21 | PO BOX 56, SCOTTSBORO, AL, 357680056, US | 506 HARLEY ST, SCOTTSBORO, AL, 357684219, US | |||||||||||||||||||
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| Phone | +1 256-574-6157 |
| Fax | 2562590560 |
Authorized person
| Name | OSCAR V, FADUL |
| Role | OWNER |
| Phone | 2565746157 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD.9585 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FADUL, OSCAR | Agent | 7850 MEMORIAL PKWYHUNTSVILLE, AL 35802 |
| Name | Role | Address |
|---|---|---|
| FADUL, OSCAR | Member | 7850 MEMORIAL PKWYHUNTSVILLE, AL 35802 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
