Healthcare Provider Details

I. General information

NPI: 1528392289
Provider Name (Legal Business Name): RANDOLPH PRIMARY CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N COX ST STE 6
ASHEBORO NC
27203-5514
US

IV. Provider business mailing address

350 N COX ST STE 6
ASHEBORO NC
27203-5514
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-2201
  • Fax: 336-629-2205
Mailing address:
  • Phone: 336-629-2201
  • Fax: 336-629-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAAD AMIN
Title or Position: PRESIDENT & PROVIDER
Credential: MD
Phone: 336-629-2201