# JOHN RANDOLPH FAMILY PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chester Medical Group, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659330843
- **Authorized official:** CAROL SMITH (VICE PRESIDENT)
- **Authorized official phone:** (804) 237-7760

## Contact information

- **Practice address:** 12900 JEFFERSON DAVIS HWY, CHESTER, VA 23831-5311
- **Practice address phone:** (804) 414-0300
- **Practice address fax:** (804) 414-0319
- **Mailing address:** 12900 JEFFERSON DAVIS HWY, CHESTER, VA 23831-5311
- **Mailing address phone:** (804) 414-0300
- **Mailing address fax:** (804) 414-0319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/17/2006
- **Last updated:** 06/17/2009