Provider Demographics
NPI:1841402138
Name:BEASON, RANDALL CAMERON (AT,C)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:CAMERON
Last Name:BEASON
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 ANGEL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-5735
Mailing Address - Country:US
Mailing Address - Phone:256-239-4795
Mailing Address - Fax:
Practice Address - Street 1:1419 HAMRIC DR E
Practice Address - Street 2:SUITE 201
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2173
Practice Address - Country:US
Practice Address - Phone:256-241-3242
Practice Address - Fax:256-832-1966
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer