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RESERVOIR FAMILY MEDICAL CLINIC, P.A.

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Company Details

Name: RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 08 Jul 2003 (22 years ago)
Business ID: 736089
ZIP code: 39047
County: Rankin
State of Incorporation: MISSISSIPPI
Principal Office Address: 216 Avalon Circle, Suite ABrandon, MS 39047

Agent

Name Role Address
WES DAUGHDRILL Agent 141 Township Avenue, Suite 300, Ridgeland, MS 39157

Incorporator

Name Role Address
Charles N Crenshaw Iii Incorporator 616 Grant's Ferry Rd, Brandon, MS 39047

Director

Name Role Address
Charles N. Crenshaw III Director 1679 Old Fannin Road Suite E, Flowood, MS 39232

President

Name Role Address
Charles N. Crenshaw III President 1679 Old Fannin Road Suite E, Flowood, MS 39232

Secretary

Name Role Address
Cari Jayne Clarkson Secretary 1679 Old Fannin Road Suite E, Flowood, MS 39232

National Provider Identifier

NPI Number:
1770929713

Authorized Person:

Name:
DR. CHARLES NAURICE CRENSHAW III
Role:
OWNER/PHYSICAN
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6019925684

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2021-11-29 Action of Intent to Dissolve: AR: RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Notice to Dissolve/Revoke Filed 2021-09-07 Notice of Intent to Dissolve: AR: RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Annual Report Filed 2020-04-09 Annual Report For RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Annual Report Filed 2019-04-10 Annual Report For RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Annual Report Filed 2018-04-13 Annual Report For RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Annual Report Filed 2017-04-11 Annual Report For RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Annual Report Filed 2016-09-22 Annual Report For RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Notice to Dissolve/Revoke Filed 2016-09-06 Notice to Dissolve/Revoke
Annual Report Filed 2015-10-08 Annual Report For RESERVOIR FAMILY MEDICAL CLINIC, P.A.
Notice to Dissolve/Revoke Filed 2015-09-16 Notice to Dissolve/Revoke

USAspending Awards / Financial Assistance

Date:
2020-04-13
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
22800.00
Total Face Value Of Loan:
22800.00

Paycheck Protection Program

Jobs Reported:
3
Initial Approval Amount:
$22,800
Date Approved:
2020-04-13
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$22,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$22,948.67
Servicing Lender:
Community Bank of Mississippi
Use of Proceeds:
Payroll: $15,791.56
Utilities: $3,195.11
Healthcare: $3813.33

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Date of last update: 30 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website