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General NPI Number Information
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NPI Number | 1124002175
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Entity Type | Individual
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Provider Name | M. BARRY RANDALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 930 MADISON AVE SUITE 890
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City | MEMPHIS
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State | TN
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Zip | 38103-3410
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Country | US
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Telephone | 901-866-8834
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Fax | 901-302-2834
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Provider Business Mailing Address
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Address Line | 1068 CRESTHAVEN RD STE 300
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City | MEMPHIS
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State | TN
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Zip | 38119-0809
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Country | US
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Telephone |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 29321
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 29321
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License Number State | TN
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