Provider Demographics
NPI:1164872529
Name:RANDOLPH, SAVANNAH ASHLEE (CRNP)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ASHLEE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:ASHLEE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:730 COOL SPRINGS BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7331
Mailing Address - Country:US
Mailing Address - Phone:773-292-4800
Mailing Address - Fax:312-564-4059
Practice Address - Street 1:2 CHASE CORPORATE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1016
Practice Address - Country:US
Practice Address - Phone:773-292-4800
Practice Address - Fax:312-564-4059
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1112879363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-112879OtherAL-LICENSE