Gilmore Randell, Tiffany

Gilmore Randell, Tiffany is an sole proprietor health care provider with primary practice located at 101 Devant Street, Office 401, Fayetteville GA 30214. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as her primary health care specialty. Gilmore Randell, Tiffany can be contacted via phone (404) 585-5439.

Contact Information

Primary practice address
101 Devant Street, Office 401 Fayetteville GA 30214
Phone: (404) 585-5439
Fax: (678) 802-0398
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X PSY00365 Georgia

Profile Details

NPI number 1245655893
LBN Legal business name Gilmore Randell, Tiffany
Credentials PSY.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 19th, 2014
Last updated Feb 19th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245655893 NPPES
Georgia MEDICAID 430767825A

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