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NPI Code Detail

MEDICARE: RANDOLPH P COUSINS PA

MEDICARE: RANDOLPH P COUSINS PA
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
1363AM0700XMedical Physician Assistant004428GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1004428OTHERGALICENSE NUMBER

General Provider Information

NPI Number : 1730260019
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDOLPH P COUSINS PA
Provider Business Mailing Address
First Line : 7301 BLACKMON RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-4478
Country : US
Telephone Number : 706-568-2700
Fax Number : 706-568-2705
Provider Business Practice Location Address
First Line : 7301 BLACKMON RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-4478
Country : US
Telephone Number : 706-568-2700
Fax Number : 706-568-2705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 07/08/2007

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Directions to “ RANDOLPH P COUSINS PA” Practice Location

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