| Doctor Name: | ALICIA HERMAN RANDOLPH |
| NPI Number: | 1386680668 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 35373 |
| Business Practice Address: | 1114 Gallatin Rd N Madison, TN - 371152738 |
| Business Phone Number: | 6158689959 |
| Business Fax Number: | 6158651463 |
| Mailing Address: | 1114 Gallatin Rd N, MADISON |
| State: | TN |
| Postal Code: | 371152738 |
| Phone Number: | 6158689959 |
| Fax Number: | 6158681463 |
| NPI Enumeration Date: | 06/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 35373 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |