Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN012512 | GA |
N | 1223G0001X | General Practice | DN012512 | GA |
N | 213EG0000X | General Practice | DN012512 | GA |
NPI | 1033260898 |
---|---|
Provider Name | Dr. Janine E. Randall |
First Address | Atlanta, GA 30339-5750 |
Second Address | Atlanta, GA 30339-5750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 17/07/2015 |