| Name: | Clarke County Family Practice, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Apr 2006 (19 years ago) |
| Entity Number: | 000-610-818 |
| Register Number: | 000610818 |
| County: | Clarke |
| Place of Formation: | Georgia |
| Principal Address: | 33700 HWY 43THOMASVILLE, AL 36784 |
| Principal Address ZIP Code: | 36784 |
Activities
HOSPITAL & HEALTHCARE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033225818 | 2006-08-22 | 2007-07-17 | 33650 HIGHWAY 43, SUITE 300, THOMASVILLE, AL, 367843336, US | 33650 HIGHWAY 43, SUITE 300, THOMASVILLE, AL, 367843336, US | |||||||||||||||||||||||||
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| Phone | +1 334-636-0757 |
| Fax | 3346360760 |
Authorized person
| Name | MRS. DINAH PRITCHETT |
| Role | OFFICE MANAGER |
| Phone | 3346365311 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 00026983 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF ALABAMA |
| Number | 515-35275 |
| State | AL |
| Name | Role |
|---|---|
| SIMS, LISA | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
