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General NPI Number Information
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NPI Number | 1760810766
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Entity Type | Individual
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Provider Name | RANDALL ALAN HANSON JR. D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 293 N BROAD ST
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City | WINDER
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State | GA
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Zip | 30680-2155
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Country | US
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Telephone | 770-867-4110
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 742616
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City | ATLANTA
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State | GA
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Zip | 30374-2616
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Country | US
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Telephone | 770-219-8420
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001293
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License Number State | GA
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