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Brookhaven Diabetes and Primary Care Clinic, LLC

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Company Details

Name: Brookhaven Diabetes and Primary Care Clinic, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 05 May 2025 (a month ago)
Business ID: 1486158
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
Surbrina A. F. Cameron Agent 1038 Forbes Drive, McComb, MS 39648

Organizer

Name Role Address
AMY CASE Organizer 1806 New Sight Dr. NE, Brookhaven, MS 39601

National Provider Identifier

NPI Number:
1275321754
Certification Date:
2025-05-03

Authorized Person:

Name:
MRS. AMY CASE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LA2200X - Adult Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Filings

Type Status Filed Date Description
Formation Form Filed 2025-04-18 Formation For Brookhaven Diabetes and Primary Care Clinic, LLC

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Date of last update: 01 May 2025

Sources: Company Profile on Mississippi Secretary of State Website