Provider Demographics
NPI:1609008986
Name:RANDOLPH, LAKEITHA MICHELLE (CNA)
Entity type:Individual
Prefix:
First Name:LAKEITHA
Middle Name:MICHELLE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 JOHNS ROAD
Mailing Address - Street 2:WONDER CARE HOME HEALTH
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31601
Mailing Address - Country:US
Mailing Address - Phone:478-225-4887
Mailing Address - Fax:
Practice Address - Street 1:343 JOHNS ROAD
Practice Address - Street 2:WONDER CARE HOME HEALTH
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31601
Practice Address - Country:US
Practice Address - Phone:478-225-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide