Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 040766 | GA |
N | 208600000X | Surgeon | 040766 | GA |
N | 2082S0105X | Plastic Hand Surgeon | 040766 | GA |
NPI | 1144206467 |
---|---|
Provider Name | Peter Michael Randle |
First Address | Atlanta, GA 30342-2606 |
Second Address | Atlanta, GA 30342-2606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G18326 | (02) | GA |