Healthcare Provider Details

I. General information

NPI: 1194334227
Provider Name (Legal Business Name): MR. RANDOLPH EVAN BELCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 04/30/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 MACON RD STE F
COLUMBUS GA
31907-2292
US

IV. Provider business mailing address

3907 MACON RD STE F
COLUMBUS GA
31907-2292
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-8006
  • Fax:
Mailing address:
  • Phone: 706-221-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000748
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: