Active NPI
Victoria Randle, FNP-C
- Family Nurse Practitioner
- Austell, GA
National Provider Identifier
1083083810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN199251
- Practice address
- 6130 Hotel St
Austell, GA 30106-4623 - Phone
- (770) 726-3577
- Fax
- (770) 522-6228
- NPI assigned
- Sep 22, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN199251 | GA | Primary |
Addresses
Primary practice location
6130 Hotel St
Austell, GA 30106-4623
Mailing address
5284 Floyd Rd SW Unit 842
Mableton, GA 30126-6106
Phone (770) 726-3577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003167991K | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230710000053 | GA | Practitioner - Nurse Practitioner | 6002118197 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN199251 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| H.E.R.O. Institute LLC | Current | Accepting new patients |
Locations
6130 Hotel St
Austell, GA 30106
Phone (770) 726-3577
2847 Veterans Memorial Hwy SW
Unit 1322
Austell, GA 30168
5284 Floyd Rd SW
Unit 842
Mableton, GA 30126
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750896000000",
"number": "1083083810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5284 FLOYD RD SW UNIT 842",
"city": "MABLETON",
"state": "GA",
"postal_code": "301266106",
"telephone_number": "770-726-3577",
"fax_number": "770-522-6228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6130 HOTEL ST",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301064623",
"telephone_number": "770-726-3577",
"fax_number": "770-522-6228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDLE",
"first_name": "VICTORIA",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-22",
"last_updated": "2025-06-26",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN199251",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003167991K",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.