Healthcare Provider Details

I. General information

NPI: 1134506058
Provider Name (Legal Business Name): AFC PHYSICIANS OF GEORGIA PRIMARY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PARKWAY DR
FT. OGLETHORPE GA
30742
US

IV. Provider business mailing address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

V. Phone/Fax

Practice location:
  • Phone: 706-956-2846
  • Fax: 706-956-2850
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-421-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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