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NPI Code Detail

MEDICARE: ADVANCED FAMILY MEDICINE LLC

MEDICARE: ADVANCED FAMILY MEDICINE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician34007672JOH

General Provider Information

NPI Number : 1417139338
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED FAMILY MEDICINE LLC
Provider Business Mailing Address
First Line : 4160 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3024
Country : US
Telephone Number : 614-875-0079
Fax Number : 614-875-2008
Provider Business Practice Location Address
First Line : 4160 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3024
Country : US
Telephone Number : 614-875-0079
Fax Number : 614-875-2008
Authorized Official
Title or Position : OWNER
Name : MR. JAMES CAMERON JOHNSON
Credential : D.O.
Telephone Number : 614-875-0079
Provider Enumeration Date : 12/03/2007
Last Update Date : 08/31/2012

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Directions to “ADVANCED FAMILY MEDICINE LLC ” Practice Location

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