| Name: | DeShazo Medical LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Series Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 11 Jan 2018 (7 years ago) |
| Date of dissolution: | 28 Dec 2021 |
| Entity Number: | 000-506-327 |
| Register Number: | 000506327 |
| County: | Shelby |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 4387 BOULDER LAKE CIRCLEBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386290781 | 2019-08-13 | 2019-08-13 | 4387 BOULDER LAKE CIR, VESTAVIA, AL, 352422116, US | 4387 BOULDER LAKE CIR, VESTAVIA, AL, 352422116, US | |||||||||||||
|
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| Phone | +1 205-492-0126 |
Authorized person
| Name | DR. MEGAN DESHAZO |
| Role | CHIEF MEDICAL OFFICER |
| Phone | 2059004321 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| DESHAZO, MEGAN E | Agent |
| Name | Role | Address |
|---|---|---|
| WILLOUGHBY, ANTHONY C | Organizer | P.O. BOX 1387BIRMINGHAM, AL 35201 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
