Healthcare Provider Details

I. General information

NPI: 1245204882
Provider Name (Legal Business Name): RANDY F RIZOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DR NE SUITE 100
SANDY SPRINGS GA
30328-6141
US

IV. Provider business mailing address

790 CHURCH ST NE SUITE 550
MARIETTA GA
30060-7282
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-3000
  • Fax: 678-904-5797
Mailing address:
  • Phone: 770-419-9902
  • Fax: 770-419-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number022875
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number022875
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: