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NPI Code Detail

MEDICARE: WILLIAM LEWIS RANDALL PA-C

MEDICARE: WILLIAM LEWIS RANDALL PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363A00000XPhysician AssistantNC

General Provider Information

NPI Number : 1285625707
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM LEWIS RANDALL PA-C
Provider Business Mailing Address
First Line : 6600 VAN AALST BLVD
Second Line :
City : FORT BENNING
State : GA
Zip : 31905-2102
Country : US
Telephone Number : 762-408-1340
Fax Number :
Provider Business Practice Location Address
First Line : 6600 VAN AALST BLVD
Second Line :
City : FORT BENNING
State : GA
Zip : 31905-2102
Country : US
Telephone Number : 762-408-1340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 04/01/2025

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Directions to “ WILLIAM LEWIS RANDALL PA-C” Practice Location

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