Provider Demographics
NPI:1780934893
Name:RANDALL CRUM INC.
Entity type:Organization
Organization Name:RANDALL CRUM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-297-5141
Mailing Address - Street 1:130 CANAL ST
Mailing Address - Street 2:STE. 601
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4085
Mailing Address - Country:US
Mailing Address - Phone:912-330-0979
Mailing Address - Fax:912-330-3710
Practice Address - Street 1:130 CANAL ST
Practice Address - Street 2:STE. 601
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4085
Practice Address - Country:US
Practice Address - Phone:912-330-0979
Practice Address - Fax:912-330-0739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANDALL CRUM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic