Provider Demographics
NPI:1043706740
Name:RANDOLF, JAMES JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RANDOLF
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 N BRIGHTLEAF BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4604
Mailing Address - Country:US
Mailing Address - Phone:919-934-8163
Mailing Address - Fax:910-934-8163
Practice Address - Street 1:332 N BRIGHTLEAF BLVD STE A
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4604
Practice Address - Country:US
Practice Address - Phone:919-934-8163
Practice Address - Fax:910-934-8163
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1549237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist