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General NPI Number Information
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NPI Number | 1992885586
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Entity Type | Organization
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Legal Business Name | MICHAEL D. RANDELL, M.D., P.C.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 5667 PEACHTREE DUNWOODY RD STE 280
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City | ATLANTA
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State | GA
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Zip | 30342-1714
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Country | US
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Telephone | 404-250-4443
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Fax | 404-250-4423
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Provider Business Mailing Address
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Address Line | 5667 PEACHTREE DUNWOODY RD STE 280
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City | ATLANTA
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State | GA
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Zip | 30342-1714
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Country | US
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Telephone | 404-250-4443
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Fax | 404-250-4423
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL DAVID RANDELL
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Credential | MD
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Telephone | 404-250-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 040200
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License Number State | GA
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