Healthcare Provider Details

I. General information

NPI: 1164042941
Provider Name (Legal Business Name): RANDOLPH JAMES SCHWEINBERG II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 ORCHARD HILL RD
MILLEDGEVILLE GA
31061-2549
US

IV. Provider business mailing address

205 N ROCK ISLAND DR
EATONTON GA
31024-5219
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-4721
  • Fax:
Mailing address:
  • Phone: 321-759-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4878
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC012462
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4878
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: