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Individual

DONNA W RANDOLPH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1726 POPLAR AVE, MEMPHIS, TN 38104-6426
(901) 274-3550
(901) 274-3551
Mailing address
1726 POPLAR AVE, DEPT 299, MEMPHIS, TN 38104-6426
(901) 274-3550
(901) 274-3551

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD24938
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
103I165972
MEDICARE PTAN
TN
05
3093788
TN
05
3099789
TN
05
3373068
TN
Enumeration date
08/18/2005
Last updated
05/11/2015
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