TIFFANY GILMORE RANDELL (NPI# 1245655893) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245655893 |
| Entity Type | Individual |
| Full Name | TIFFANY GILMORE RANDELL |
| Credential | PSY.D. |
| Practice Address |
101 Devant Street Office 401 Fayetteville GA 30214 |
| Mailing Address |
1415 Hwy 85 N Ste 310-222 Fayetteville GA 30214 |
| Practice Telephone | 4045855439 |
| Practice Fax Number | 6788020398 |
| Mailing Telephone | 4045855439 |
| Mailing Fax Number | 6788020398 |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2014-02-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PSY00365 | GA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 430767825A | 05 |
| Street Address |
101 DEVANT STREET, OFFICE 401 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841342342 | Robert H Jenkins | Psychologist | 711b Executive Pl, Fayetteville, NC 28305-5125 | 2007-01-17 |
| 1629145784 | Amy Beth Gross | Psychologist | 6834 E Genesee St, Fayetteville, NY 13066-1021 | 2006-11-30 |
| 1649420688 | Sherry Hoang Smith | Psychologist | 711 Executive Pl, Fayetteville, NC 28305-5193 | 2008-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538693254 | Rachel Yosick | Psychologist | 520 Wembley Cir, Sandy Springs, GA 30328-6753 | 2017-04-19 |
| 1174974620 | Warren Umansky, Ph.d. | Psychologist | 302 Wheeler Executive Ctr, Augusta, GA 30909 | 2016-06-27 |
| 1972927861 | Tyrone D. Lane Enterprises, Incorporated | Psychologist | 5304 Panola Industrial Boulevard, Suite L, Decatur, GA 30035 | 2014-02-12 |
| 1720409493 | Tonya Favors | Psychologist | 311 S Lee St, Apt C, Americus, GA 31709-3971 | 2013-12-26 |
| 1912336546 | Francine Adams | Psychologist | 324 Trace Ln, Lawrenceville, GA 30046-2896 | 2013-11-04 |
| 1447542691 | Erin Marie Jones | Psychologist | 1256 Briarcliff Rd Ne Ste 322e, Atlanta, GA 30306-2636 | 2011-05-06 |
| 1164729901 | Tiffany Whitworth | Psychologist | 4139 Hospital Dr Ne, Covington, GA 30014-2565 | 2011-02-14 |
| 1548573264 | Kimberley Blaker Saye | Psychologist | 4695 Mahonia Way Nw, Acworth, GA 30102-3575 | 2010-07-22 |
| 1316269350 | Caitlin Herzinger Delfs | Psychologist | 4994 Lower Roswell Rd Ste 10, Marietta, GA 30068-4332 | 2010-02-18 |
| 1831323849 | Shital Pramod Gaitonde | Psychologist | 1003 Bombay Ln, Roswell, GA 30076-5820 | 2009-05-05 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on TIFFANY GILMORE RANDELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.