Provider Demographics
NPI:1720243561
Name:SHIPLEY, RANDAL KRIS (MD)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:KRIS
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 PHILEMA RD APT 46
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-6619
Mailing Address - Country:US
Mailing Address - Phone:407-506-5021
Mailing Address - Fax:
Practice Address - Street 1:219 PHILEMA RD APT 46
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-6619
Practice Address - Country:US
Practice Address - Phone:407-506-5021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine