Individual
DR. JOHN RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 LIBERTY BLVD, LIBERTY, SC 29657-1641
(864) 843-8500
(864) 843-5634
Mailing address
PO BOX 919, PICKENS, SC 29671-0919
(864) 897-8277
(864) 878-0035
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24613
SC
207Q00000X
Family Medicine Physician
35074072
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2141300
—
OH
Enumeration date
05/23/2005
Last updated
10/14/2014
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