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General NPI Number Information
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NPI Number | 1265667935
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Entity Type | Organization
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Legal Business Name | RANDY GEORGEMILLER, PH.D., P.C.
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Dates
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Enumeration Date | 05/23/2009
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 4115 COLUMBIA RD SUITE 5-305
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City | MARTINEZ
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State | GA
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Zip | 30907-0405
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Country | US
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Telephone | 847-913-5175
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Fax |
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Provider Business Mailing Address
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Address Line | 4115 COLUMBIA RD SUITE 5-305
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City | MARTINEZ
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State | GA
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Zip | 30907-0405
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Country | US
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Telephone | 847-913-5175
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDY GEORGEMILLER
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Credential | PH.D.
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Telephone | 847-913-5175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071003110
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License Number State | IL
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