Provider Demographics
NPI:1659360600
Name:BISHOP, RANDOLPH C (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:C
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61356
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31420-1356
Mailing Address - Country:US
Mailing Address - Phone:912-348-9495
Mailing Address - Fax:912-348-9496
Practice Address - Street 1:8880 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4508
Practice Address - Country:US
Practice Address - Phone:912-713-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041516207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00705537AMedicaid
SCG41516Medicaid
GA00705537AMedicaid
F95651Medicare UPIN
GA140005214Medicare PIN
SCF956515823Medicare PIN