Individual ProviderMalik Jajuan RandolphBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address7491 Mossdale Way, Columbus, GA 31909-1787(850) 266-4697PECOS EnrollmentBased on the most recent information from CMS, provider Malik Jajuan Randolph does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1710624895Provider TypeIndividualFull NameRandolph, Malik JajuanGenderMaleSole ProprietorNoEnumeration Date5/19/2022Last Updated5/19/2022Contact InformationPractice LocationPractice Address7491 Mossdale Way, Columbus, GA 31909-1787Phone(850) 266-4697FaxUnlisted FaxMailing LocationMailing Address7491 Mossdale Way, Columbus, GA 31909-1787Phone(850) 266-4697FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseRBT-22-206971Georgia