Individual
RANDOLPH P COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7301 BLACKMON RD, COLUMBUS, GA 31909-4478
(706) 568-2700
(706) 568-2705
Mailing address
7301 BLACKMON RD, COLUMBUS, GA 31909-4478
(706) 568-2700
(706) 568-2705
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004428
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004428
LICENSE NUMBER
GA
Enumeration date
10/17/2006
Last updated
07/08/2007
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