| Doctor Name: | MR. GREGORY W RANDOLPH |
| NPI Number: | 1699760652 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 13081 |
| Business Practice Address: | 130 Fleitas Ave Pass Christian, MS - 395714507 |
| Business Phone Number: | 2284524888 |
| Business Fax Number: | 2284525006 |
| Mailing Address: | 130 Fleitas Ave, PASS CHRISTIAN |
| State: | MS |
| Postal Code: | 395714507 |
| Phone Number: | 2284524888 |
| Fax Number: | 2284525006 |
| NPI Enumeration Date: | 09/15/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 13081 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |