Provider Demographics
NPI:1720031503
Name:BERINHOUT, RANDALL CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:CHARLES
Last Name:BERINHOUT
Suffix:
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 1:165 N PARK TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6500
Mailing Address - Country:US
Mailing Address - Phone:770-506-1800
Mailing Address - Fax:770-506-4686
Practice Address - Street 1:165 N PARK TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6500
Practice Address - Country:US
Practice Address - Phone:770-506-1800
Practice Address - Fax:770-506-4686
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034777208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000478277KMedicaid
GAA93159Medicare UPIN
GA000478277KMedicaid