Individual
MARK PATRICK RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2503 WOOTEN BLVD SW, WILSON, NC 27893-4426
(252) 243-2268
(252) 243-2917
Mailing address
PO BOX 3127, WILSON, NC 27895-3127
(252) 243-2268
(252) 243-2917
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
103783
NC
Other
Enumeration date
08/26/2005
Last updated
12/08/2020
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