Provider Demographics
NPI:1760665459
Name:RANDALL WOOLEN, GIA S (PA)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:S
Last Name:RANDALL WOOLEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GIA
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 ST VINCENTS DR
Mailing Address - Street 2:POB 1 SUITE #720
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-930-2456
Mailing Address - Fax:
Practice Address - Street 1:810 SAINT VINCENTS DR # 720
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1601
Practice Address - Country:US
Practice Address - Phone:205-930-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052202363A00000X
GA006451363A00000X
AL.821363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant