Provider Demographics
NPI:1750013470
Name:SKAGGS, RANDALL BRIAN
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:BRIAN
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5615
Mailing Address - Country:US
Mailing Address - Phone:937-203-6516
Mailing Address - Fax:
Practice Address - Street 1:1245 DAVIS DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5615
Practice Address - Country:US
Practice Address - Phone:937-203-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion