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General NPI Number Information
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NPI Number | 1598703456
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Entity Type | Individual
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Provider Name | ERICH GRAHAM RANDOLPH MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 320 PARKWAY DR NE 300
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City | ATLANTA
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State | GA
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Zip | 30312-1213
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Country | US
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Telephone | 404-522-6569
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Fax | 404-522-8265
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Provider Business Mailing Address
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Address Line | 1072 W PEACHTREE ST NW UNIT 77114
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City | ATLANTA
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State | GA
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Zip | 30357-3016
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Country | US
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Telephone | 404-300-2476
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Fax | 404-250-8010
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 021790
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 021790
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License Number State | GA
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