Provider Demographics
NPI:1265879977
Name:AFC PHYSICIANS OF GEORGIA, PC
Entity type:Organization
Organization Name:AFC PHYSICIANS OF GEORGIA, PC
Other - Org Name:<UNAVAIL>
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 1:3481 ERNEST BARRETT PARKWAY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2703
Practice Address - Country:US
Practice Address - Phone:678-348-5119
Practice Address - Fax:678-348-5120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFC PHYSICIANS OF GEORGIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-04
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G70834Medicare Oscar/Certification