Provider Demographics
NPI:1265667935
Name:RANDY GEORGEMILLER, PH.D., P.C.
Entity Type:Organization
Organization Name:RANDY GEORGEMILLER, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGEMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-913-5175
Mailing Address - Street 1:4115 COLUMBIA RD
Mailing Address - Street 2:SUITE 5-305
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0405
Mailing Address - Country:US
Mailing Address - Phone:847-913-5175
Mailing Address - Fax:
Practice Address - Street 1:4115 COLUMBIA RD
Practice Address - Street 2:SUITE 5-305
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0405
Practice Address - Country:US
Practice Address - Phone:847-913-5175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-23
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty