| Name: | Family Practice Clinic, P. A. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Corporation |
| Status: | Revoked |
| Entity Number: | 000-861-404 |
| Register Number: | 000861404 |
| Place of Formation: | South Carolina |
| Principal Address: | P O BOX 518MANNING, SC |
| Registered Office Street Address: | 924 MONTCLARE ROADBIRMINGHAM, AL |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003060328 | 2008-11-13 | 2008-11-13 | 1245 WESTGATE PKWY, DOTHAN, AL, 36303, US | 403 MIDLAND ST, ASHFORD, AL, 36312, US | |||||||||||||||||
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| Phone | +1 334-793-9595 |
| Fax | 3347931578 |
| Phone | +1 334-899-3363 |
Authorized person
| Name | MRS. JOYCE HUFFAKER |
| Role | PRACTICE MANAGER |
| Phone | 3347939595 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| ROBERTS, JIMMY N | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
