Healthcare Provider Details

I. General information

NPI: 1326066010
Provider Name (Legal Business Name): RANDY D. PROFFITT, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 PICCADILLY SQUARE DR
MOBILE AL
36609-5103
US

IV. Provider business mailing address

6317 PICCADILLY SQUARE DR
MOBILE AL
36609-5103
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-0322
  • Fax: 251-344-0395
Mailing address:
  • Phone: 251-344-0322
  • Fax: 251-344-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDY DOUGLAS PROFFITT
Title or Position: OWNER
Credential:
Phone: 251-344-0322