Provider Demographics
NPI:1447614136
Name:RANDOLPH, SALLEE TAYLOR (DPM)
Entity type:Individual
Prefix:DR
First Name:SALLEE
Middle Name:TAYLOR
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SALLEE
Other - Middle Name:RAYE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1303 SUNSET DR STE 6
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7905
Mailing Address - Country:US
Mailing Address - Phone:423-232-1771
Mailing Address - Fax:
Practice Address - Street 1:1303 SUNSET DR STE 6
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-232-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN848213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery