Healthcare Provider Details

I. General information

NPI: 1033260898
Provider Name (Legal Business Name): JANINE E. RANDALL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 PACES FERRY RD SE SUITE D
ATLANTA GA
30339-5750
US

IV. Provider business mailing address

4199 PACES FERRY RD SE SUITE D
ATLANTA GA
30339-5750
US

V. Phone/Fax

Practice location:
  • Phone: 770-373-4601
  • Fax:
Mailing address:
  • Phone: 770-373-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN012512
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012512
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: