| Name: | The Coulter Clinic, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 11 Sep 2024 (4 months ago) |
| Entity Number: | 001-153-891 |
| Register Number: | 001153891 |
| ZIP code: | 35611 |
| County: | Limestone |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 1405 S. Jefferson StreetAthens, AL 35611 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710709654 | 2024-10-31 | 2024-10-31 | 1405 SW JEFFERSON ST, ATHENS, AL, 356113531, US | 1405 SW JEFFERSON ST, ATHENS, AL, 356113531, US | |||||||||||||||||||||
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| Phone | +1 256-780-0216 |
| Fax | 2567800218 |
Authorized person
| Name | MORGAN BATES COULTER |
| Role | CLINIC OWNER, FNP |
| Phone | 2567800216 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PROVIDER LICENSE NUMBER |
| Number | 1-154372 |
| State | AL |
| Name | Role |
|---|---|
| Coulter, Morgan B | Agent |
Date of last update: 16 Sep 2024
Sources: Alabama Secretary of State
