Provider Demographics
NPI:1043526528
Name:AMERICAN FAMILY CARE TENNESSEE, LLC
Entity Type:Organization
Organization Name:AMERICAN FAMILY CARE TENNESSEE, LLC
Other - Org Name:AMERICAN FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-421-2102
Mailing Address - Street 1:2147 RIVERCHASE OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1836
Mailing Address - Country:US
Mailing Address - Phone:205-403-8902
Mailing Address - Fax:205-982-0278
Practice Address - Street 1:6606 CHARLOTTE PIKE
Practice Address - Street 2:STE# 104
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4202
Practice Address - Country:US
Practice Address - Phone:615-630-6095
Practice Address - Fax:615-630-6099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FAMILY CARE TENNESSEE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty