Healthcare Provider Details

I. General information

NPI: 1174287379
Provider Name (Legal Business Name): RMX BLACKSHEAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 US HIGHWAY 84 STE 102
BLACKSHEAR GA
31516-2160
US

IV. Provider business mailing address

3345 US HIGHWAY 84 STE 102
BLACKSHEAR GA
31516-2160
US

V. Phone/Fax

Practice location:
  • Phone: 912-208-3581
  • Fax:
Mailing address:
  • Phone: 912-208-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDALL CRAWFORD
Title or Position: MANAGER
Credential:
Phone: 912-208-3581