| NPI | 1497808182 |
|---|---|
| Doing Business As | DR. RANDOLPH'S AGELESS & WELLNESS MEDICAL CENTER |
| Entity Type | Organization |
| Authorized Contact | NICOLE THOMAS Owner 904-249-3749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL me0042493) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-11-05 |