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NPI Code Detail

MEDICARE: PETER MICHAEL RANDLE M.D.

MEDICARE: PETER MICHAEL RANDLE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician040766GA
22082S0099XPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician040766GA
32082S0105XSurgery of the Hand (Plastic Surgery) Physician040766GA

General Provider Information

NPI Number : 1144206467
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER MICHAEL RANDLE M.D.
Provider Business Mailing Address
First Line : 4890 ROSWELL RD NE
Second Line : P O BOX 421967
City : ATLANTA
State : GA
Zip : 30342-2606
Country : US
Telephone Number : 770-712-1911
Fax Number :
Provider Business Practice Location Address
First Line : 4890 ROSWELL RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30342-2606
Country : US
Telephone Number : 770-712-1911
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 09/11/2025

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Directions to “ PETER MICHAEL RANDLE M.D.” Practice Location

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