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NPI Code Detail

MEDICARE: AFC PHYSICIANS OF GEORGIA, PC

MEDICARE: AFC PHYSICIANS OF GEORGIA, PC
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
1208D00000XGeneral Practice PhysicianGA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1202G708342OTHERGAMCR PTAN

General Provider Information

NPI Number : 1982025318
Entity Type Code : Organization
Provider Name (Legal Business Name) : AFC PHYSICIANS OF GEORGIA, PC
Provider Business Mailing Address
First Line : 2147 RIVERCHASE OFFICE RD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35244-1836
Country : US
Telephone Number : 205-403-8902
Fax Number : 205-421-2109
Provider Business Practice Location Address
First Line : 6509 GATEWAY RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-5681
Country : US
Telephone Number : 706-243-0174
Fax Number : 706-243-0178
Authorized Official
Title or Position : PRESIDENT
Name : RANDY JOHANSEN
Credential :
Telephone Number : 205-403-8902
Provider Enumeration Date : 01/03/2014
Last Update Date : 01/03/2014

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