Gregory W Randolph, MD
Individual provider Active NPI General Practice Physician · Pass Christian, MS
NPI 1699760652 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1699760652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 13081 (MS)
- Practice address
- 130 Fleitas Ave
Pass Christian, MS 39571-4507 - Phone
- (228) 452-4888
- Fax
- (228) 452-5006
- NPI assigned
- Sep 15, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150123000998 | MS | Order and Referring Only - General Practice |
1557685492 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 13081 | MS | Yes |
Addresses
Primary practice location
130 Fleitas Ave
Pass Christian, MS 39571-4507
Mailing address
130 Fleitas Ave
Pass Christian, MS 39571-4507
Phone (228) 452-4888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00117253 | Medicaid | MS |
Other providers in Pass Christian, MS
- Pensacola Health Trust Inc
- Pensacola Health Trust Inc
- Laura Pipoly
- Alicia Puckett
- Kathleen Caboni Quinn
- Mary Reardon
- Jazmin Rials
- Donna B Rice
- Theresa Robinson
- Mark Schmidt
All providers in Pass Christian, MS · General Practice Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.