| Name: | Grace Pediatrics LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 02 Feb 2007 (18 years ago) |
| Entity Number: | 000-489-776 |
| Register Number: | 000489776 |
| County: | Autauga |
| Place of Formation: | Autauga County |
| Principal Address: | PRATTVILLE, AL |
| Registered Office Street Address: | 138 BRYAN STPRATTVILLE, AL 36066 |
| Registered Office Street Address ZIP Code: | 36066 |
Activities
PEDIATRIC MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548301914 | 2007-02-09 | 2020-08-22 | 138 BRYAN ST, PRATTVILLE, AL, 360665348, US | 74186 TALLASSEE HWY, SUITE B, WETUMPKA, AL, 360925643, US | |||||||||||||||||||||||
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| Phone | +1 334-358-5145 |
| Fax | 3343585145 |
| Phone | +1 334-567-0346 |
| Fax | 3345670855 |
Authorized person
| Name | DR. MICHELLE P MEDINA |
| Role | SINGLE MEMBER |
| Phone | 3343585145 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 22736 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| MEDINA, MICHELLE | Agent |
| Name | Role |
|---|---|
| MEDINA, MICHELLE | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
