| Name: | DR. GRAHAM PSYCHIATRIC SERVICES LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 Mar 2018 (7 years ago) (Companies founded in March 2018) |
| Entity Number: | 000-514-228 |
| Register Number: | 000514228 |
| ZIP code: | 35802 (Companies in Madison, 35802) |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 600 BOULEVARD SOUTH SW SUITE 104-AHUNTSVILLE, AL 35802 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316444912 | 2018-04-10 | 2018-04-10 | 256 HONEYSUCKLE RD STE 2, DOTHAN, AL, 363051168, US | 256 HONEYSUCKLE RD STE 2, DOTHAN, AL, 363051168, US | |||||||||||||||||||||||||
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| Phone | +1 334-792-6736 |
| Fax | 3347926737 |
Authorized person
| Name | DR. LEONA J GRAHAM |
| Role | OWNER |
| Phone | 3347926736 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | MD.33645 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003153440A |
| State | AL |
| Name | Role |
|---|---|
| LEGALINC CORPORATE SERVICES INC | Agent |
| Name | Role | Address |
|---|---|---|
| SIHA, MARSHA | Organizer | 17350 STATE HWY 249, SUITE 220HOUSTON, TX 77064 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
