Provider Demographics
NPI:1780021337
Name:MANSELL, RANDALL KEITH II (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:KEITH
Last Name:MANSELL
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11407, DEPT# 5839
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:256-386-1125
Mailing Address - Fax:888-745-7084
Practice Address - Street 1:1120 S JACKSON HWY STE 105
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5770
Practice Address - Country:US
Practice Address - Phone:256-386-1125
Practice Address - Fax:888-745-7084
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1845208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery