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General NPI Number Information
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NPI Number | 1659440006
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Entity Type | Organization
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Legal Business Name | SHIRLEY M. RANDALL INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 9507 HOSPITAL AVE
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City | NASSAWADOX
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State | VA
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Zip | 23413
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Country | US
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Telephone | 757-414-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3105 AMERICAN LEGION RD STE E
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5654
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Country | US
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Telephone | 757-483-7706
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Fax | 757-483-7726
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANNETTE JOHN
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Credential |
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Telephone | 757-483-7706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101034675
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License Number State | VA
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