Provider Demographics
NPI:1699952234
Name:ZANDERS, RANDY LEON JR
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:LEON
Last Name:ZANDERS
Suffix:JR
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 1:1439 JOHNSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560
Mailing Address - Country:US
Mailing Address - Phone:843-394-7490
Mailing Address - Fax:843-394-7479
Practice Address - Street 1:1439 JOHNSONVILLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2523
Practice Address - Country:US
Practice Address - Phone:843-394-7490
Practice Address - Fax:843-394-7479
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance