NPIMap

Organization Active NPI

Afc Physicians of Tennessee, PC

  • General Practice Physician
  • Clarksville, TN
National Provider Identifier
1639508666
Registry record updated Jun 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
AFC PHYSICIANS OF TENNESSEE, PC
Practice address
1763 Madison Street Commons
Clarksville, TN 37043
Phone
(931) 278-8000
Fax
(931) 278-8004
NPI assigned
Nov 12, 2013
Last updated
Jun 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
AFC PHYSICIANS OF TENNESSEE, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Randy Johansen
Title
President
Phone
(054) 212-1012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X TN Primary

Addresses

Primary practice location

1763 Madison Street Commons
Clarksville, TN 37043

Mailing address

3700 Cahaba Beach Rd
Birmingham, AL 35242-5225
Phone (205) 403-8902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110128000880 TN Part B Supplier - Clinic/Group Practice 5395924823 Receives reassigned benefits from 114 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Knoxville, TN; Spring Hill, TN; Smyrna, TN; Nashville, TN; Hendersonville, TN; Clarksville, TN; Chattanooga, TN; Mt. Juliet, TN…

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Afc Physicians of Tennessee7 organizations share this tax ID, including this one
Part of
Afc Physicians of Tennessee

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

291 Indian Lake Blvd
Hendersonville, TN 37075
Phone (615) 265-5008

6606 Charlotte Pike
Ste 104
Nashville, TN 37209
Phone (615) 630-6095

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1639508666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 CAHABA BEACH RD",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352425225",
            "telephone_number": "205-403-8902",
            "fax_number": "205-421-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1763 MADISON STREET COMMONS",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "931-278-8000",
            "fax_number": "931-278-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFC PHYSICIANS OF TENNESSEE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AFC PHYSICIANS OF TENNESSEE, PC",
        "enumeration_date": "2013-11-12",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "JOHANSEN",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "054-212-1012",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.