Individual provider Active NPI

Victoria Randle, FNP-C

  • Family Nurse Practitioner
  • Austell, GA
National Provider Identifier
1083083810
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN199251 Issued in GA
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

Updated by the provider on Jun 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
003167991KMedicaidGA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230710000053 GA Practitioner - Nurse Practitioner 6002118197

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN199251GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
H.E.R.O. Institute LLC CurrentSince Oct 1, 2018 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

Verify at the official NPI Registry.