| Name: | Camellia Dermatology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 24 Feb 2021 (4 years ago) (Companies founded in February 2021) |
| Entity Number: | 000-837-213 |
| Register Number: | 000837213 |
| ZIP code: | 36606 (Companies in Mobile, 36606) |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | 3280 DAUPHIN ST BLDG AMOBILE, AL 36606 |
| Authorized Capital: | 1000@$1.00PV |
Activities
ENGAGE IN PROFESSION OF MEDICINE & SERVICES RELATED THERETO
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639753148 | 2021-05-11 | 2021-05-11 | 1851 N MCKENZIE ST, SUITE 104, FOLEY, AL, 36535, US | 1851 N MCKENZIE ST, SUITE 104, FOLEY, AL, 36535, US | |||||||||||||||
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| Phone | +1 251-450-3700 |
| Fax | 2512636333 |
Authorized person
| Name | AMY ANANTH |
| Role | PROVIDER |
| Phone | 2514503700 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| FOREFRONT MEDICAL MANAGEMENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| THOMPSON, CHRIS | Incorporator | 1901 SIXTH AVE N STE 1400BIRMINGHAM, AL 35203 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
