MEDICARE: AMERICAN FAMILY CARE NETWORK OF GEORGIA

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
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1912246406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN FAMILY CARE NETWORK OF GEORGIA

Provider Business Mailing Address
First Line	:	1514 CLEVELAND AVE
Second Line	:	SUITE 120
City	:	EAST POINT
State	:	GA
Zip	:	30344-6965
Country	:	US
Telephone Number	:	919-423-2277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 CLEVELAND AVE
Second Line	:	SUITE 120
City	:	EAST POINT
State	:	GA
Zip	:	30344-6965
Country	:	US
Telephone Number	:	919-423-2277
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	CORY TITO FRANCIS
Credential	:
Telephone Number	:	919-423-2277

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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