Healthcare Provider Details

I. General information

NPI: 1285284893
Provider Name (Legal Business Name): AFFINITY ACQUISITIONS GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SAMMY MCGHEE BLVD STE 202
JASPER GA
30143-7712
US

IV. Provider business mailing address

135 GEMINI CIR STE 202
BIRMINGHAM AL
35209-5842
US

V. Phone/Fax

Practice location:
  • Phone: 706-403-4033
  • Fax: 800-625-7404
Mailing address:
  • Phone: 205-949-0400
  • Fax: 205-949-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS SEFCIK
Title or Position: CFO
Credential:
Phone: 205-949-0400