Provider Demographics
NPI:1902078892
Name:RANDALL D. AYERS
Entity Type:Organization
Organization Name:RANDALL D. AYERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DEDE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-562-8180
Mailing Address - Street 1:1718 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:STE-C
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4708
Mailing Address - Country:US
Mailing Address - Phone:205-562-8180
Mailing Address - Fax:205-553-4575
Practice Address - Street 1:1718 VETERANS MEMORIAL PKWY
Practice Address - Street 2:STE-C
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-4708
Practice Address - Country:US
Practice Address - Phone:205-562-8180
Practice Address - Fax:205-553-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73015Medicare UPIN