Provider Demographics
NPI:1235542754
Name:HINES, RANDY II (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:HINES
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 JACKSON ST NE APT 3111
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-7917
Mailing Address - Country:US
Mailing Address - Phone:409-549-9652
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE STE 216
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6442
Practice Address - Country:US
Practice Address - Phone:470-956-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6824207Q00000X
GA78836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine