Provider Demographics
NPI:1851339428
Name:NEWMAN, RANDALL I (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:I
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2171 W PARK CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3555
Mailing Address - Country:US
Mailing Address - Phone:678-514-1991
Mailing Address - Fax:678-514-1993
Practice Address - Street 1:2701 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5918
Practice Address - Country:US
Practice Address - Phone:404-501-5265
Practice Address - Fax:404-501-5266
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033656207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000542946BMedicaid
GAF59023Medicare UPIN
GA05BDDKJMedicare PIN