| Name: | Southern Retina, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 30 Jan 2002 (23 years ago) (Companies founded in January 2002) |
| Date of dissolution: | 31 May 2016 |
| Entity Number: | 000-680-164 |
| Register Number: | 000680164 |
| ZIP code: | 35205 (Companies in Jefferson, 35205) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 1201 11TH AVE SOUTH STE 300BIRMINGHAM, AL 35205 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013949890 | 2006-07-06 | 2020-08-22 | 250 STATE FARM PKWY, BIRMINGHAM, AL, 352097181, US | 250 STATE FARM PKWY, BIRMINGHAM, AL, 352097181, US | |||||||||||||||||||||
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| Phone | +1 205-943-4600 |
| Fax | 2059434688 |
Authorized person
| Name | ROBERT MORRIS |
| Role | PRESIDENT/OWNER |
| Phone | 2059434600 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE PGBA |
| Number | CJ9053 |
| State | AL |
| Name | Role |
|---|---|
| MORRIS, ROBERT E | Agent |
| Name | Role |
|---|---|
| MORRIS, ROBERT E | Member |
| WITHERSPOON, C DOUGLAS | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
