| Field | Data |
|---|---|
| EIN | 84-3834224 |
| Case Number | EO-2020273-000485 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | CLARKSTON IMAGING CLINIC INC |
| Organization’s Mailing Address | 593 SCOTT CIRCLE |
| City | DECATUR |
| State | GA |
| ZIP | 30033 |
| Accounting period End | 12 |
| Primary contact name | DEAN WONG THONGKHAM |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
DEAN WONG THONGKHAM
PRESIDENT
593 SCOTT CIRCLE
DECATUR GA 30033
CHARLOTTE CHUNG
VICE PRESIDENT
593 SCOTT CIRCLE
DECATUR GA 30033
NABILE SAFDAR
TREASURER
593 SCOTT CIRCLE
DECATUR GA 30033
HERNON BELLO VELEZ
SECRETARY
593 SCOTT CIRCLE
DECATUR GA 30033
SADHNA NANDWANA
BOARD MEMBER AT LARGE
593 SCOTT CIRCLE
DECATUR GA 30033
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 11/19/2019 |
| Organization Incorporation State | GA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E60 - Health Support Services |
| Organization’s purpose | Charitable: No Religious: No Educational: No Scientific: Yes Literary: No Public Safety: No Amateur Sports: No Cruelty Prevention: No |
| Qualify For Exemption | No |
| Legislation influence | No |
| Compensation of Officer director trustee | No |
| Donation of funds | No |
| Conducting Activities Outside of United States | No |
| Financial transactions with officers | No |
| Unrelated Gross Income $1,000 or More | No |
| Gaming Activity | No |
| Disaster relief assistance | No |
| One Third Support Public | No |
| One Third Support Gifts | Yes |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | DEAN WONG THONGKHAM |
| Signature Title | PRESIDENT |
| Signature Date | 9/24/2020 |
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