DR. ATHENA R RANDOLPH (NPI# 1972603876) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972603876 |
| Entity Type | Individual |
| Full Name | DR. ATHENA R RANDOLPH |
| Credential | M.D. |
| Practice Address |
1847 Sw Barnett Way Lake City FL 32025-6957 |
| Practice Telephone | 3867551440 |
| Practice Fax Number | 3867585628 |
| Mailing Telephone | 3867551440 |
| Mailing Fax Number | 3867585628 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-01-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | ME51982 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | AVMED | 030560 | 01 |
| FL | 061740700 | 05 | |
| FL | NPI | 1972603876 | 01 |
| FL | AETNA | 0004131285 | 01 |
| FL | BCBS | 11281 | 01 |
| Street Address |
1847 SW BARNETT WAY |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025-6957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346249406 | Matthew Neil Melvin | Nurse Practitioner | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2005-07-20 |
| 1356500987 | Milla Pediatrics and Associates, Inc | Pediatrics | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2008-06-09 |
| 1386726578 | Milla Pediatrics & Associates, Inc. | Pediatrics | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2006-10-19 |
| 1144320052 | Randolph Medical Practices Pa | Pediatrics | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2006-09-22 |
| 1992805881 | Tommy Lavaughn Randolph | Family Medicine | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2006-09-22 |
| 1639179435 | Johnna L Jackson | Nurse Practitioner | 1847 Sw Barnett Way, Lake City, FL 32025 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033253133 | John Street Clinic PC | Pediatrics | 112 E John St, Lake City, MI 49651 | 2007-02-20 |
| 1508823394 | Maria D. Smith | Pediatrics | 426 Sw Commerce Dr, Suite 101, Lake City, FL 32025-1505 | 2006-04-27 |
| 1639711237 | Brittany Lynn Bailey | Pediatrics | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2019-10-15 |
| 1639557069 | Jennifer Nguyen Simpson | Pediatrics | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2015-05-18 |
| 1053727081 | Amna Zarar | Pediatrics | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2014-07-10 |
| 1295155869 | Mohammed Al-nufal | Pediatrics | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2014-04-22 |
| 1720345259 | James Dungca | Pediatrics | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2012-04-22 |
| 1992099576 | Adrienne Hope Mott-young | Pediatrics | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2011-06-01 |
| 1356513964 | Magnolia Pediatrics LLC | Pediatrics | 1140 Sw Bascom Norris Dr Ste 104, Lake City, FL 32025-1329 | 2008-03-24 |
| 1982775128 | Milla Pediatrics and Associates, Inc. | Pediatrics | 426 Sw Commerce Dr, Suite 101, Lake City, FL 32025-1505 | 2006-11-10 |
| Find all providers in LAKE CITY | ||||
Please comment or provide details below to improve the information on DR. ATHENA R RANDOLPH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.