| Name: | Randy D. Proffitt, M.D., LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Nov 2005 (19 years ago) |
| Entity Number: | 000-470-817 |
| Register Number: | 000470817 |
| ZIP code: | 36695 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 2802 CHURCHBELL COURTMOBILE, AL 36695 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326066010 | 2006-07-18 | 2015-01-27 | 6317 PICCADILLY SQUARE DR, MOBILE, AL, 366095103, US | 6317 PICCADILLY SQUARE DR, MOBILE, AL, 366095103, US | |||||||||||||||||||||||||||
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| Phone | +1 251-344-0322 |
| Fax | 2513440395 |
Authorized person
| Name | RANDY D PROFFITT |
| Role | PRESIDENT |
| Phone | 2516070300 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 51531824 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051531824 |
| State | AL |
| Name | Role |
|---|---|
| PROFFITT, RANDY D | Agent |
| Name | Role |
|---|---|
| PROFFITT, RANDY D | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
