Healthcare Provider Details

I. General information

NPI: 1265427090
Provider Name (Legal Business Name): HUEY RANDOLPH KIDD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33650 HIGHWAY 43
THOMASVILLE AL
36784-3305
US

IV. Provider business mailing address

24B CAMDEN BYP
CAMDEN AL
36726-1770
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-5311
  • Fax: 334-636-2280
Mailing address:
  • Phone: 334-882-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-0546
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: