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NPI Code Detail

MEDICARE: MS. MARANDA RANDOLPH LCSW

MEDICARE: MS. MARANDA RANDOLPH LCSW
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
11041C0700XClinical Social WorkerCSW005439GA

General Provider Information

NPI Number : 1982098521
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARANDA RANDOLPH LCSW
Provider Business Mailing Address
First Line : 1201 W PEACHTREE ST NW STE 2346
Second Line :
City : ATLANTA
State : GA
Zip : 30309-3453
Country : US
Telephone Number : 678-960-9207
Fax Number : 678-965-0270
Provider Business Practice Location Address
First Line : 1201 W PEACHTREE ST NW STE 2346
Second Line :
City : ATLANTA
State : GA
Zip : 30309-3453
Country : US
Telephone Number : 678-960-9207
Fax Number : 678-965-0270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2015
Last Update Date : 02/01/2019

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