| Name: | Provision 2, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Aug 2021 (3 years ago) |
| Entity Number: | 000-877-021 |
| Register Number: | 000877021 |
| County: | Cullman |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 340 County Road 1635Cullman, AL 35058 |
| Registered Office Street Address ZIP Code: | 35058 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366119802 | 2021-08-24 | 2021-08-24 | 340 COUNTY ROAD 1635, CULLMAN, AL, 35058, US | 1809 DAHLKE DRIVE, CULLMAN, AL, 35058, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-339-9979 |
Authorized person
| Name | DR. ROBERT WAYNE SMITH |
| Role | OWNER |
| Phone | 2563399979 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207QG0300X - Geriatric Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 2084B0040X - Behavioral Neurology & Neuropsychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
| Name | Role |
|---|---|
| Smith, Robert W M.D. | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
