Healthcare Provider Details

I. General information

NPI: 1043526528
Provider Name (Legal Business Name): AMERICAN FAMILY CARE TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 CHARLOTTE PIKE STE# 104
NASHVILLE TN
37209-4202
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
BIRMINGHAM AL
35244-1836
US

V. Phone/Fax

Practice location:
  • Phone: 615-630-6095
  • Fax: 615-630-6099
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-982-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDY JOHANSEN
Title or Position: PRESIDENT
Credential:
Phone: 205-421-2102