Provider Demographics
NPI:1770925521
Name:THOMAS, RANDI THERESA
Entity type:Individual
Prefix:MISS
First Name:RANDI
Middle Name:THERESA
Last Name:THOMAS
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 1:905 WALTON WAY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3870
Mailing Address - Country:US
Mailing Address - Phone:678-849-6695
Mailing Address - Fax:
Practice Address - Street 1:905 WALTON WAY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3870
Practice Address - Country:US
Practice Address - Phone:678-849-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide