Individual
SETH RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
300 W HOSPITAL RD, FORT GORDON, GA 30905-5741
(865) 719-9633
Mailing address
300 W HOSPITAL RD, FORT GORDON, GA 30905-5741
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
171250
TN
367500000X
Certified Registered Nurse Anesthetist
29868
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171250
TRICARE
TN
Enumeration date
09/16/2019
Last updated
05/27/2025
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