Healthcare Provider Details

I. General information

NPI: 1629890843
Provider Name (Legal Business Name): LARHONDA RANDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MANCHESTER EXPY STE A005
COLUMBUS GA
31904-6805
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE A005
COLUMBUS GA
31904-6805
US

V. Phone/Fax

Practice location:
  • Phone: 706-257-7680
  • Fax:
Mailing address:
  • Phone: 706-257-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP002863
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: