Active NPI
Altheal Randolph, PA
- Medical Physician Assistant
- Jemison, AL
National Provider Identifier
1376093864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA190
- Practice address
- 340 County Road 126
Jemison, AL 35085-3106 - Phone
- (205) 908-8304
- Fax
- (205) 688-2545
- NPI assigned
- Oct 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA190 | AL | Primary |
Addresses
Primary practice location
340 County Road 126
Jemison, AL 35085-3106
Mailing address
340 County Road
Jemison, AL 35085-3106
Phone (205) 908-8304
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA190 | AL | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475798400000",
"number": "1376093864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 COUNTY ROAD",
"city": "JEMISON",
"state": "AL",
"postal_code": "350853106",
"telephone_number": "205-908-8304",
"fax_number": "205-688-2545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 COUNTY ROAD 126",
"city": "JEMISON",
"state": "AL",
"postal_code": "350853106",
"telephone_number": "205-908-8304",
"fax_number": "205-688-2545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "ALTHEAL",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-07",
"last_updated": "2016-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AL",
"license": "PA190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jemison, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.