Healthcare Provider Details

I. General information

NPI: 1720008311
Provider Name (Legal Business Name): AMERICAN FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 RIVERCHASE OFFICE RD
HOOVER AL
35244-1836
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
HOOVER AL
35244-1836
US

V. Phone/Fax

Practice location:
  • Phone: 205-403-8902
  • Fax: 205-982-7882
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-982-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4241
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4241
License Number StateAL

VIII. Authorized Official

Name: DR. EDWIN RONALD GRAY
Title or Position: EMPLOYEE
Credential: M.D.
Phone: 256-424-5875