Individual
SHELBY JOYCE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1459 LANEY WALKER BLVD, AUGUSTA, GA 30912-0002
(916) 626-2206
Mailing address
2178 AMHERST WAY, EL DORADO HILLS, CA 95762-5943
(916) 626-2206
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
10796
GA
207P00000X
Emergency Medicine Physician
Primary
20A20015
CA
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
20A20015
CA
207RA0401X
Addiction Medicine (Internal Medicine) Physician
20A20015
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10796
—
GA
Enumeration date
04/18/2019
Last updated
10/17/2024
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