Healthcare Provider Details

I. General information

NPI: 1033806310
Provider Name (Legal Business Name): WILLIAM FURTICK RANDALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 N GROVE MEDICAL PARK DR STE 100
SPARTANBURG SC
29303-4227
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-582-8135
  • Fax: 864-573-9757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number96608
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: