| Name: | Magnolia Family Practice, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Jan 2024 (10 months ago) |
| Entity Number: | 001-114-853 |
| Register Number: | 001114853 |
| County: | Autauga |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 1841 Glynwood DrPrattville, AL 36066 |
| Registered Office Street Address ZIP Code: | 36066 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205692407 | 2024-02-26 | 2024-08-12 | 1841 GLYNWOOD DR, PRATTVILLE, AL, 360665584, US | 1841 GLYNWOOD DR, PRATTVILLE, AL, 360665584, US | |||||||||||||||
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| Phone | +1 334-568-5025 |
| Fax | 3345695040 |
Authorized person
| Name | JENNIFER MAGUIRE GROFF |
| Role | OWNER |
| Phone | 3345685025 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| Groff, Jennifer | Agent |
Date of last update: 18 Aug 2024
Sources: Alabama Secretary of State
