Healthcare Provider Details

I. General information

NPI: 1992249635
Provider Name (Legal Business Name): RANDI CAROLINE KOZLOWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 01/16/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CANDLER DR STE 300
SAVANNAH GA
31405-6091
US

IV. Provider business mailing address

836 E 65TH ST STE 4
SAVANNAH GA
31405-4491
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-6187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN206907
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN206907
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: