Randall B Fulford, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA3183 Issued in FL

Practice address

96279 Brady Point Rd
Fernandina Beach, FL 32034-7076

Phone

(904) 321-0088

NPI assigned

Mar 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Florida Medical Care,PA

  • Internal Medicine Physician
  • Leesburg, FL
  • NPI 1144265026
  NPD (past)
• Medlink Management Services Inc

  • Critical Access Hospital
  • Lake Butler, FL
  • NPI 1013972272
  NPD (past)
• Robert a. Norman, D.O., P.a.

  • Dermatology Physician
  • Riverview, FL
  • NPI 1952440711
  NPD (past)
• Southeast Orthopedic Specialists, LLC

  • Orthopaedic Surgery Physician
  • Jacksonville, FL
  • NPI 1629025820
  NPD (past)
• Advanced Pediatric Specialists LLC

  • Pediatrics Physician
  • Savannah, GA
  • NPI 1073046397
  NPD (past)

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1295795896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7131 KING ARTHUR RD N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322114108",
            "telephone_number": "904-338-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96279 BRADY POINT RD",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320347076",
            "telephone_number": "904-321-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULFORD",
        "first_name": "RANDALL",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004674",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002029D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002029B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01157676",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002029C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2909961-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark William Floyd, MD
• Stacey Sara Foley, DPT
• Mary Alice Foote, PHARMD
• Virginia Wall Foxworth, LMHC
• Nicole Frazee-Stewart, PTA
• Fuller Health & Wellness, LLC
• Ivanna Fux Kahn, PA-C
• Caroline Aline Garner
• Steven A Garrett, DMD
• Robin N Gasparini, DNP, APRN, ACNS, BC

• Physician Assistant in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.