Provider Demographics
NPI:1639743842
Name:ATKINSON, RANDI SHANNEL
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:SHANNEL
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3164
Mailing Address - Country:US
Mailing Address - Phone:678-344-7836
Mailing Address - Fax:
Practice Address - Street 1:2795 MAIN ST W
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3164
Practice Address - Country:US
Practice Address - Phone:678-656-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator