Healthcare Provider Details

I. General information

NPI: 1316953714
Provider Name (Legal Business Name): AMERICAN FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6631 PARK DR
DAPHNE AL
36526-5227
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
BIRMINGHAM AL
35244
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-5700
  • Fax: 251-626-5705
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-982-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDY A JOHANSEN
Title or Position: PRESIDENT
Credential:
Phone: 205-421-2102