Provider Demographics
NPI:1841637378
Name:LAVENDER, RANDY C JR (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:C
Last Name:LAVENDER
Suffix:JR
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:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3590
Mailing Address - Fax:706-389-3811
Practice Address - Street 1:2470 DANIELLS BRIDGE RD STE 301
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6188
Practice Address - Country:US
Practice Address - Phone:706-389-3590
Practice Address - Fax:706-389-3811
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93479207X00000X, 207X00000X, 207XS0114X
LA328483207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003276101DMedicaid