| Name: | Magnolia Medical, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Series Limited Liability Company |
| Status: | Exists |
| Date of registration: | 15 Feb 2021 (4 years ago) (Companies founded in February 2021) |
| Entity Number: | 000-835-417 |
| Register Number: | 000835417 |
| ZIP code: | 35983 (Companies in Cherokee, 35983) |
| County: | Cherokee |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 2820 AL HWY 68 WestSand Rock, AL 35983 |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RYASZ7M9GB55 | 2023-11-03 | 2820 AL- 68 WEST, LEESBURG, AL, 35983, USA | 2820 AL - 68 WEST, LEESBURG, AL, 35983, USA | |||||||||||||||||||||||||||||||||||||||
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| Congressional District | 03 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2022-11-07 |
| Initial Registration Date | 2022-11-03 |
| Entity Start Date | 2021-02-02 |
| Fiscal Year End Close Date | Oct 31 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | ASHLEY LACKEY |
| Role | DR. |
| Address | 2820 AL - 68 WEST, LEESBURG, AL, 35983, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | ASHLEY LACKEY |
| Role | DR. |
| Address | 2820 AL - 68 WEST, LEESBURG, AL, 35983, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851976054 | 2021-03-10 | 2022-04-09 | 2820 AL HIGHWAY 68 W, SANDROCK, AL, 359834200, US | 2820 AL HIGHWAY 68 W, SANDROCK, AL, 359834200, US | |||||||||||||||||||||||||
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| Phone | +1 256-523-3627 |
| Fax | 2565231503 |
| Phone | +1 205-386-4341 |
Authorized person
| Name | ENRICO D GASPAR |
| Role | OWNER |
| Phone | 2568408181 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role |
|---|---|
| Lackey, Ashley | Agent |
| Name | Role | Address |
|---|---|---|
| LACKEY, ASHLEY | Organizer | 2820 AL HWY 68 WSAND ROCK, AL 35983 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
