Healthcare Provider Details

I. General information

NPI: 1366485617
Provider Name (Legal Business Name): AFFINITY PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 GRANDVIEW PKWY STE 820
BIRMINGHAM AL
35243-3408
US

IV. Provider business mailing address

3690 GRANDVIEW PKWY
BIRMINGHAM AL
35243-3326
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-3000
  • Fax: 205-971-4910
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L JACKSON
Title or Position: SR DIR PROV ENROLL & ONBOARDING
Credential:
Phone: 615-465-3334