Healthcare Provider Details

I. General information

NPI: 1669455606
Provider Name (Legal Business Name): CHRISTOPHER SCOTT RANDOLPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LEIGHTON AVE SUITE 303
ANNISTON AL
36207-5700
US

IV. Provider business mailing address

PO BOX 1782
ANNISTON AL
36202-1782
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-0744
  • Fax: 256-235-0761
Mailing address:
  • Phone: 256-235-0744
  • Fax: 256-235-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number16710
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16710
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: