Provider Demographics
NPI:1003959305
Name:RANDY G MCCOMB, MD, PC
Entity type:Organization
Organization Name:RANDY G MCCOMB, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-737-5720
Mailing Address - Street 1:151 FOREST HILL IRENE RD S
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4824
Mailing Address - Country:US
Mailing Address - Phone:901-737-5720
Mailing Address - Fax:
Practice Address - Street 1:151 FOREST HILL IRENE RD S
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4824
Practice Address - Country:US
Practice Address - Phone:901-737-5720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000023564207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND16986Medicare UPIN