Provider Demographics
NPI:1659409720
Name:KORNEGAY, JAMES RANDALL (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RANDALL
Last Name:KORNEGAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 KORNEGAY DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066
Mailing Address - Country:US
Mailing Address - Phone:334-285-3070
Mailing Address - Fax:334-285-6164
Practice Address - Street 1:711 KORNEGAY DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066
Practice Address - Country:US
Practice Address - Phone:334-285-3070
Practice Address - Fax:334-285-6164
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist