| Name: | Henagar Family Medicine, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 Feb 2004 (21 years ago) (Companies founded in February 2004) |
| Entity Number: | 000-697-920 |
| Register Number: | 000697920 |
| ZIP code: | 35978 (Companies in De Kalb, 35978) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Principal Address: | HENAGAR, AL |
| Registered Office Street Address: | 18324 AL HWY 75HENAGAR, AL 35978 |
Activities
PROVIDE MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740375732 | 2006-10-04 | 2014-06-11 | P.O. BOX 518, HENAGAR, AL, 35978, US | 18324 ALABAMA HIGHWAY 75, HENAGAR, AL, 35978, US | |||||||||||||||||||||
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| Phone | +1 256-657-1101 |
| Fax | 2566571115 |
Authorized person
| Name | DR. ANTHONY SIMS |
| Role | OWNER |
| Phone | 2566571101 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051522432 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SIMS, ANTHONY | Agent | 18324 ALABAMA HIGHWAY 75HENAGAR, AL 35978 |
| Name | Role | Address |
|---|---|---|
| SIMS, ANTHONY | Member | 18324 ALABAMA HIGHWAY 75HENAGAR, AL 35978 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
