Provider Demographics
NPI:1538146055
Name:DEARMENT, RANDALL L (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:DEARMENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2438
Mailing Address - Country:US
Mailing Address - Phone:256-216-9777
Mailing Address - Fax:256-233-9776
Practice Address - Street 1:902 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2438
Practice Address - Country:US
Practice Address - Phone:256-216-9777
Practice Address - Fax:256-233-9776
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006945208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5198640Medicaid
MI5198640Medicaid
MIC36088096Medicare PIN