Provider Demographics
NPI:1902960719
Name:REDMOND PHYSICIAN PRACTICE COMPANY
Entity Type:Organization
Organization Name:REDMOND PHYSICIAN PRACTICE COMPANY
Other - Org Name:RANDOLPH P SUMNER MD FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:100 JOHN MADDOX DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1431
Mailing Address - Country:US
Mailing Address - Phone:706-290-9222
Mailing Address - Fax:706-290-0045
Practice Address - Street 1:100 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1431
Practice Address - Country:US
Practice Address - Phone:706-290-9222
Practice Address - Fax:706-290-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB6391Medicare PIN
GAGRP2870Medicare PIN