Individual
CARLA R RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
305 PAUL BRYANT DR E, TUSCALOOSA, AL 35401-2094
(205) 345-0192
(205) 247-2194
Mailing address
305 PAUL BRYANT DR E, TUSCALOOSA, AL 35401-2094
(205) 345-0192
(205) 247-2194
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-267
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51507969
BLUE CROSS BLUE SHIELD
AL
Enumeration date
06/08/2006
Last updated
07/08/2007
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