Individual
DR. JACQUETTA TAISHA RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
451 RUIN CREEK RD, SUITE 101, HENDERSON, NC 27536-2878
(252) 492-9565
Mailing address
451 RUIN CREEK RD, SUITE 101, HENDERSON, NC 27536-2878
(252) 492-9565
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2012-01956
NC
208000000X
Pediatrics Physician
A111970
CA
Other
Enumeration date
05/17/2010
Last updated
10/29/2012
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