Provider Demographics
NPI:1942290846
Name:RANDO, STEPHEN N (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:N
Last Name:RANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4808
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31213
Mailing Address - Country:US
Mailing Address - Phone:478-477-8955
Mailing Address - Fax:
Practice Address - Street 1:770 PINE ST
Practice Address - Street 2:STE 290
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-633-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0140912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00006905AMedicaid
GA00006905AMedicaid
E89467Medicare UPIN