Healthcare Provider Details

I. General information

NPI: 1902465461
Provider Name (Legal Business Name): RANDALL B WASSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR
ABINGDON VA
24211-7664
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DR
ABINGDON VA
24211-7664
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-4435
  • Fax:
Mailing address:
  • Phone: 276-258-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4629
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: