| Name: | Southern Grace Medical Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 16 Mar 2020 (5 years ago) |
| Entity Number: | 000-625-649 |
| Register Number: | 000625649 |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 209 LONGWOOD DRIVE SWHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MVFKDMRKE4D1 | 2025-03-25 | 209 LONGWOOD DR SW, HUNTSVILLE, AL, 35801, 5243, USA | 209 LONGWOOD DRIVE, S.W., HUNTSVILLE, AL, 35801, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Congressional District | 05 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2024-03-28 |
| Initial Registration Date | 2024-03-20 |
| Entity Start Date | 2020-03-16 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 485991, 485999, 524114, 541519, 541611, 541612, 541613, 541614, 541618, 561110, 611430, 621111, 621112, 621330, 621399, 621999, 713940 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | GEORGE TAYLOR |
| Role | CHIEF EXECUTIVE OFFICER |
| Address | 209 LONGWOOD DRIVE S.W., HUNTSVILLE, AL, 35801, USA |
| Title | ALTERNATE POC |
| Name | DR. DAVONIA TAYLOR |
| Role | CHIEF CLINICAL OFFICER |
| Address | 209 LONGWOOD DRIVE S.W., HUNTSVILLE, AL, 35801, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | GEORGE TAYLOR |
| Role | CHIEF EXECUTIVE OFFICER |
| Address | 209 LONGWOOD DRIVE S.W., HUNTSVILLE, AL, 35801, USA |
| Title | ALTERNATE POC |
| Name | DR. DAVONIA TAYLOR |
| Role | CHIEF CLINICAL OFFICER |
| Address | 209 LONGWOOD DRIVE S.W., HUNTSVILLE, AL, 35801, USA |
| Past Performance | |
|---|---|
| Title | ALTERNATE POC |
| Name | DR. DAVONIA TAYLOR |
| Role | CHIEF CLINICAL OFFICER |
| Address | 209 LONGWOOD DRIVE S.W., HUNTSVILLE, AL, 35801, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649890211 | 2020-04-23 | 2020-04-23 | 1606 MOONTOWN RD, BROWNSBORO, AL, 357419493, US | 500 GOVERNORS DR SW, HUNTSVILLE, AL, 358015126, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-776-3850 |
| Phone | +1 256-797-4118 |
Authorized person
| Name | JIMMY GREGORY WINN |
| Role | FAMILY NURSE PRACTITIONER / OWNER |
| Phone | 2567974118 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | ALABAMA BOARD OF MEDICAL EXAMINERS |
| Number | 23529 |
| State | AL |
| Issuer | ALABAMA BOARD OF NURSING, RX NUMBER |
| Number | 8499 |
| State | AL |
| Issuer | ALABAMA BOARD OF NURSING, RN LICENSE NUMBER |
| Number | 1-159682 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| TAYLOR, GEORGE ANCEL JR. | Agent | 209 LONGWOOD DRIVE SWHUNTSVILLE, AL 35801 |
| Name | Role | Address |
|---|---|---|
| TAYLOR, GEORGE ANCEL JR. | Member | 209 LONGWOOD DRIVE SWHUNTSVILLE, AL 35801 |
| TAYLOR, DAVONIA K. | Member | 209 LONGWOOD DRIVE SWHUNTSVILLE, AL 35801 |
| Name | Role | Address |
|---|---|---|
| TAYLOR, GEORGE ANCEL JR. | Organizer | 209 LONGWOOD DRIVE SWHUNTSVILLE, AL 35801 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
