Healthcare Provider Details

I. General information

NPI: 1487660890
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: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 OFFICE PARK CIR 101
MT BROOK AL
35223
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
HOOVER AL
35244
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-8891
  • Fax: 205-879-7728
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-982-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDY A JOHANSEN
Title or Position: PRESIDENT
Credential:
Phone: 205-421-2101