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General NPI Number Information
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NPI Number | 1376093864
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Entity Type | Individual
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Provider Name | ALTHEAL RANDOLPH PA
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Gender | Female
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 340 COUNTY ROAD 126
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City | JEMISON
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State | AL
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Zip | 35085-3106
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Country | US
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Telephone | 205-908-8304
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Fax | 205-688-2545
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Provider Business Mailing Address
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Address Line | 340 COUNTY ROAD
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City | JEMISON
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State | AL
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Zip | 35085-3106
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Country | US
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Telephone | 205-908-8304
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Fax | 205-688-2545
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA190
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License Number State | AL
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