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General NPI Number Information
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NPI Number | 1053480178
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Entity Type | Individual
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Provider Name | RANDAL CRAIG HUMPHREY R,CT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1201 13TH AVE SE
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City | DECATUR
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State | AL
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Zip | 35601-4300
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Country | US
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Telephone | 256-350-7779
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Fax | 256-350-2272
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Provider Business Mailing Address
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Address Line | 3026 GUM POND RD
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City | BAILEYTON
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State | AL
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Zip | 35019-7014
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Country | US
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Telephone | 256-350-7779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 313224
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | 313224
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License Number State |
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