| Name: | Tanner Primary Care of Roanoke, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 18 Feb 2019 (6 years ago) |
| Entity Number: | 000-548-421 |
| Register Number: | 000548421 |
| County: | Randolph |
| Place of Formation: | Georgia |
| Principal Address: | 705 Dixie StreetCarrollton, GA 30117 |
| Registered Office Street Address: | 1032 S. Main StreetWedowee, AL 36278 |
| Registered Office Street Address ZIP Code: | 36278 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255899092 | 2019-03-12 | 2024-02-29 | 100 GREENWAY BLVD FL 2, CARROLLTON, GA, 301174338, US | 965 HIGHWAY 431, ROANOKE, AL, 362747329, US | |||||||||||||||||||||||
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| Phone | +1 770-838-8710 |
| Fax | 7708125735 |
| Phone | +1 334-863-2141 |
| Fax | 3348638733 |
Authorized person
| Name | CLINT HOFFMAN |
| Role | SR VP |
| Phone | 7708388302 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| Stitcher, Heather | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
