Provider Demographics
NPI:1780600262
Name:ALEXANDER, RANDALL (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:ALEXANDER
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 1:2061 PEACHTREE RD NE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1446
Mailing Address - Country:US
Mailing Address - Phone:404-352-3522
Mailing Address - Fax:404-352-9251
Practice Address - Street 1:2061 PEACHTREE RD NE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1446
Practice Address - Country:US
Practice Address - Phone:404-352-3522
Practice Address - Fax:404-352-9251
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050778207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00979151AMedicaid
GA00979151AMedicaid
GAH53463Medicare UPIN