Provider Demographics
NPI:1497006720
Name:RANDALL CRUM INC.
Entity Type:Organization
Organization Name:RANDALL CRUM INC.
Other - Org Name:THE SLEEP DISORDERS CENTER AT FT. STEWART GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-927-5141
Mailing Address - Street 1:790 VETERANS PARKWAY
Mailing Address - Street 2:SUITE 112 A-2
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310
Mailing Address - Country:US
Mailing Address - Phone:912-368-3709
Mailing Address - Fax:912-368-3710
Practice Address - Street 1:790 VETERANS PKWY
Practice Address - Street 2:SUITE 112 A-2
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3915
Practice Address - Country:US
Practice Address - Phone:912-368-3709
Practice Address - Fax:912-368-3710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANDALL CRUM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic