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General NPI Number Information
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NPI Number | 1871541425
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Entity Type | Individual
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Provider Name | RANDALL G WHITLOCK JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 1430 COLUMBUS AVE
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160
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Country | US
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Telephone | 740-620-4069
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Fax | 740-620-4072
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Provider Business Mailing Address
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Address Line | 1430 COLUMBUS AVE
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1703
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Country | US
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Telephone | 740-620-4069
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Fax | 740-620-4072
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50001262
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License Number State | OH
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