Healthcare Provider Details

I. General information

NPI: 1114968575
Provider Name (Legal Business Name): VARICOSITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date: 08/21/2007
Reactivation Date: 11/12/2009

III. Provider practice location address

2704 20TH ST S SUITE 410
BIRMINGHAM AL
35209-1924
US

IV. Provider business mailing address

2704 20TH ST S SUITE 410
BIRMINGHAM AL
35209-1924
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-1800
  • Fax: 205-592-1752
Mailing address:
  • Phone: 205-592-1800
  • Fax: 205-592-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLTON DUANE RANDLEMAN JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 205-592-1800