Provider Demographics
NPI:1982950671
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:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-421-2102
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 1:12994 HWY 9
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:678-205-8155
Practice Address - Fax:678-382-0440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFC PHYSICIANS OF GEORGIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-31
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