Provider Demographics
NPI:1053662189
Name:AFC PHYSICIANS OF GEORGIA, PC
Entity Type:Organization
Organization Name:AFC PHYSICIANS OF GEORGIA, PC
Other - Org Name:
Other - Org Type:
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:205-421-2101
Mailing Address - Street 1:3700 CAHABA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5225
Mailing Address - Country:US
Mailing Address - Phone:205-403-8902
Mailing Address - Fax:205-421-2109
Practice Address - Street 1:5610 ROSWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1102
Practice Address - Country:US
Practice Address - Phone:678-916-2129
Practice Address - Fax:678-916-2123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFC PHYSICIANS OF GEORGIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-28
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care