| Provider / Organization | NPI | Date Certified |
|---|---|---|
| COURTNEY RANDALL | 1265041362 | 2021-06-02 |
Courtney Randall is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1265041362. Registration indicates Courtney Randall is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers)
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Courtney Randall NP |
| Practice Office Address | 6261 PEAKE RD MACON, GA US |
| Practice Office Telephone | 4786335660 |
| Mailing Address | 6261 PEAKE RD MACON, GA 312108074 US |
| Business Telephone | 4786335660 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 5398 Thomaston Rd | Macon, GA 312208110 | 4787438316 / 4787431824 |
| Code | Practice | License No State |
|---|---|---|
| 363L00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner All Other Specialties & Provider Types Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers | 215483
GA |