| Name: | Derma Birmingham, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 Apr 2024 (9 months ago) |
| Entity Number: | 001-133-384 |
| Register Number: | 001133384 |
| ZIP code: | 35226 |
| County: | Jefferson |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 2142 TYLER ROAD, SUITE 110HOOVER, AL 35226 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104653062 | 2024-09-16 | 2024-09-16 | 2142 TYLER RD STE 110, HOOVER, AL, 352261307, US | 2142 TYLER RD STE 110, HOOVER, AL, 352261307, US | |||||||||||||||||||||||||
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| Phone | +1 205-825-5575 |
| Fax | 2058255576 |
Authorized person
| Name | DR. KATHERINE MARCHIONY HUNT |
| Role | OWNER |
| Phone | 2058877000 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 237277 |
| State | AL |
| Issuer | NPI |
| Number | 1477932192 |
| Name | Role | Address |
|---|---|---|
| Hunt, Katherine M.D. | Agent | 2710 18th Street South, Unit 59164Birmingham, AL 35209 |
| Name | Role | Address |
|---|---|---|
| Hunt, Katherine M.D. | Organizer | 2710 18th Street South, Unit 59164Birmingham, AL 35209 |
Date of last update: 18 Aug 2024
Sources: Alabama Secretary of State
