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NPI Code Detail

MEDICARE: ADVANCED FAMILY MEDICINE LLC

MEDICARE: ADVANCED FAMILY MEDICINE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2207QA0401XAddiction Medicine (Family Medicine) Physician
3363LA2200XAdult Health Nurse Practitioner
4207QA0505XAdult Medicine Physician

General Provider Information

NPI Number : 1851891279
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED FAMILY MEDICINE LLC
Provider Business Mailing Address
First Line : 4160 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3024
Country : US
Telephone Number : 614-875-0079
Fax Number :
Provider Business Practice Location Address
First Line : 4160 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3024
Country : US
Telephone Number : 614-875-0079
Fax Number :
Authorized Official
Title or Position : D.O.
Name : JAMES CAMERON JOHNSON
Credential :
Telephone Number : 614-875-0079
Provider Enumeration Date : 02/13/2018
Last Update Date : 01/27/2021

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Directions to “ADVANCED FAMILY MEDICINE LLC ” Practice Location

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