Healthcare Provider Details

I. General information

NPI: 1114086824
Provider Name (Legal Business Name): RANDOLPH WOMENS HEALTH CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E PRESNELL ST
ASHEBORO NC
27203-4744
US

IV. Provider business mailing address

311 EAST PRESNELL STREET
ASHEBORO NC
27203-4744
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-0550
  • Fax: 336-626-0650
Mailing address:
  • Phone: 336-626-0550
  • Fax: 336-626-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM C BROOKS
Title or Position: PRESIDENT
Credential: MD
Phone: 336-626-0550