| Name: | Clarke County Medical Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 15 Dec 2003 (21 years ago) |
| Entity Number: | 000-606-414 |
| Register Number: | 000606414 |
| County: | Clarke |
| Place of Formation: | Georgia |
| Principal Address: | 33700 HWY 43THOMASVILLE, AL 36784 |
| Principal Address ZIP Code: | 36784 |
Activities
MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144322306 | 2006-09-01 | 2008-04-24 | 3050 HIGHWAY 5, UNIT 134, THOMASVILLE, AL, 367844325, US | 3050 HIGHWAY 5, UNIT 134, THOMASVILLE, AL, 367844325, US | |||||||||||||||
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| Phone | +1 334-636-5311 |
| Fax | 3346362280 |
Authorized person
| Name | MRS. DINAH PRITCHETT |
| Role | OFFICE MANAGER CRNP |
| Phone | 3346365311 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| SIMS, LISA | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
