Individual
TIFFANY GILMORE RANDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
101 DEVANT STREET,, OFFICE 401, FAYETTEVILLE, GA 30214
(404) 585-5439
(678) 802-0398
Mailing address
1415 HWY 85 N, STE 310-222, FAYETTEVILLE, GA 30214
(404) 585-5439
(678) 802-0398
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY00365
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
430767825A
—
GA
Enumeration date
02/19/2014
Last updated
02/19/2014
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