Healthcare Provider Details

I. General information

NPI: 1073891792
Provider Name (Legal Business Name): AMERICAN FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 RANGELINE SERVICE RD S STE# 101
MOBILE AL
36619-9541
US

IV. Provider business mailing address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

V. Phone/Fax

Practice location:
  • Phone: 251-544-6449
  • Fax: 251-544-6450
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-421-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateAL
# 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 JOHANSEN
Title or Position: PRESIDENT
Credential:
Phone: 205-421-2101