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NPI Code Detail

MEDICARE: RANDALL L CARSON MD

MEDICARE: RANDALL L CARSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianC6040AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669469508
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL L CARSON MD
Provider Business Mailing Address
First Line : PO BOX 402319
Second Line :
City : ATLANTA
State : GA
Zip : 30384-2319
Country : US
Telephone Number : 479-709-7399
Fax Number : 479-709-7053
Provider Business Practice Location Address
First Line : 8600 S 36TH TER
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8768
Country : US
Telephone Number : 479-709-7465
Fax Number : 479-709-7466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 08/23/2010

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Directions to “ RANDALL L CARSON MD” Practice Location

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