Healthcare Provider Details

I. General information

NPI: 1972614931
Provider Name (Legal Business Name): RANDY CLYDE EFIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 YADKIN ST
ALBEMARLE NC
28001-3441
US

IV. Provider business mailing address

6135 PARK SOUTH DR STE 510
CHARLOTTE NC
28210-0100
US

V. Phone/Fax

Practice location:
  • Phone: 980-323-4000
  • Fax:
Mailing address:
  • Phone: 704-749-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number30329
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: