Provider Demographics
NPI:1528664356
Name:DOPSON, RANDI AMBER (LMA, CE, CME)
Entity type:Individual
Prefix:MS
First Name:RANDI
Middle Name:AMBER
Last Name:DOPSON
Suffix:
Gender:F
Credentials:LMA, CE, CME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 FORTUNE PKWY UNIT 1106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6757
Mailing Address - Country:US
Mailing Address - Phone:904-470-0589
Mailing Address - Fax:
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 1106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6757
Practice Address - Country:US
Practice Address - Phone:904-470-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEO3482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist