Provider Demographics
NPI:1194334227
Name:BELCHER, RANDOLPH EVAN
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:EVAN
Last Name:BELCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 MACON RD STE F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2292
Mailing Address - Country:US
Mailing Address - Phone:706-221-8006
Mailing Address - Fax:
Practice Address - Street 1:3907 MACON RD STE F
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2292
Practice Address - Country:US
Practice Address - Phone:706-221-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000748237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist