| Name: | AZALEA CITY PRIMARY CARE AND WELLNESS, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Sep 2020 (4 years ago) |
| Entity Number: | 000-646-645 |
| Register Number: | 000646645 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 3859 PICKETT DRIVEMOBILE, AL 36618 |
| Registered Office Street Address ZIP Code: | 36618 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083480453 | 2023-11-28 | 2023-11-28 | 358 SAINT LOUIS ST, MOBILE, AL, 366022825, US | 358 SAINT LOUIS ST, MOBILE, AL, 366022825, US | |||||||||||||||
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| Phone | +1 251-372-0858 |
| Fax | 2514942034 |
Authorized person
| Name | TASHA LATIYA JONES |
| Role | ADMINISTRATOR |
| Phone | 2514224336 |
Taxonomy
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JONES, TASHA | Agent | 4950 GOVERNMENT BLVDMOBILE, AL 36693 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
