Provider Demographics
NPI:1265427090
Name:KIDD, HUEY RANDOLPH (DO)
Entity type:Individual
Prefix:
First Name:HUEY
Middle Name:RANDOLPH
Last Name:KIDD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24B CAMDEN BYP
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36726-1770
Mailing Address - Country:US
Mailing Address - Phone:334-882-1919
Mailing Address - Fax:
Practice Address - Street 1:33650 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3305
Practice Address - Country:US
Practice Address - Phone:334-636-5311
Practice Address - Fax:334-636-2280
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-0546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541393401Medicaid
AL541393401Medicaid
AL051520672Medicare ID - Type Unspecified