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General NPI Number Information
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NPI Number | 1851954424
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Entity Type | Individual
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Provider Name | SHELBY JOYCE RANDALL DO
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Gender | Female
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1459 LANEY WALKER BLVD
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City | AUGUSTA
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State | GA
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Zip | 30912-0002
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Country | US
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Telephone | 916-626-2206
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Fax |
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Provider Business Mailing Address
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Address Line | 2178 AMHERST WAY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-5943
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Country | US
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Telephone | 916-626-2206
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20A20015
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | 20A20015
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 20A20015
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 10796
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License Number State | GA
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