Individual
DR. LILLY J RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2719 MIDDLEBURG DR, SUITE 103, COLUMBIA, SC 29204-2414
(803) 931-8337
(803) 931-8338
Mailing address
105 PINCKNEY DR, COLUMBIA, SC 29209-4824
(803) 783-8327
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
159928
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467402446
DBA PHYSICIANS MEDICAL GROUP OF SOUTH CAROLINA
SC
Enumeration date
05/11/2006
Last updated
10/31/2011
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