Active NPI
Tiffany Gilmore Randell, PSY.D.
- Clinical Child & Adolescent Psychologist
- Fayetteville, GA
National Provider Identifier
1245655893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PSY00365
- Practice address
- 101 Devant Street,
Office 401
Fayetteville, GA 30214 - Phone
- (404) 585-5439
- Fax
- (678) 802-0398
- NPI assigned
- Feb 19, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY00365 | GA | Primary |
Addresses
Primary practice location
101 Devant Street,
Office 401
Fayetteville, GA 30214
Mailing address
1415 Hwy 85 N
Ste 310-222
Fayetteville, GA 30214
Phone (404) 585-5439
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430767825A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY00365 | GA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392768000000",
"number": "1245655893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1415 HWY 85 N",
"address_2": "STE 310-222",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "30214",
"telephone_number": "404-585-5439",
"fax_number": "678-802-0398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 DEVANT STREET,",
"address_2": "OFFICE 401",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "30214",
"telephone_number": "404-585-5439",
"fax_number": "678-802-0398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILMORE RANDELL",
"first_name": "TIFFANY",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-19",
"last_updated": "2014-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "PSY00365",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "430767825A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.