Individual
JOHNNIE LYNN RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
246 SHADOW POINTE RD, THIBODAUX, LA 70301-8448
(985) 688-8264
Mailing address
10202 PERKINS ROWE STE E, BATON ROUGE, LA 70810-2067
(985) 601-1343
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
05/29/2025
Last updated
05/29/2025
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