Individual
MISS TIFFANY RANDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1104 REALM LN, LAWRENCEVILLE, GA 30044-2676
(404) 438-5152
Mailing address
1104 REALM LN, LAWRENCEVILLE, GA 30044-2676
(404) 438-5152
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT011209
GA
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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