Provider Demographics
NPI:1912419078
Name:RANDLEMAN FAMILY CLINIC PLLC
Entity Type:Organization
Organization Name:RANDLEMAN FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-907-7201
Mailing Address - Street 1:2806 RANDLEMAN RD STE J
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-5266
Mailing Address - Country:US
Mailing Address - Phone:336-907-7201
Mailing Address - Fax:
Practice Address - Street 1:2806 RANDLEMAN RD STE J
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5266
Practice Address - Country:US
Practice Address - Phone:336-907-7201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty