Amelia Randolph, DMD, MS

Primary specialty

DentistTaxonomy code 122300000X

License

FR3349669 Issued in FL

Practice address

1779 SW Barnett Way
Lake City, FL 32025-6957

Phone

(386) 755-4033

NPI assigned

Dec 2, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385942400000",
    "number": "1124459169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1779 SW BARNETT WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1779 SW BARNETT WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256957",
            "telephone_number": "386-755-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "AMELIA",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-02",
        "last_updated": "2013-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "FR3349669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parvathamma - Rajasekhar, M.D
• Ramkissoon Weiss Dental PLLC
• Johann Ramkissoon, DMD
• Kay B Ramnarine, PHARM D
• Randolph Medical Practices PA
• David F Randolph, DMD
• Tommy Lavaughn Randolph, M.D.
• Britany Ratliff
• Julie Marie Rattley, CMSW
• Raul B Zelaya MD PA

• Dentist in Lake City, FL
• Providers in Lake City, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.