Individual provider · Type 1 NPI
Jackson Tyler Randolph
Student in an Organized Health Care Education/Training Program · Newnan, GA
NPI number
1093695215
Active
Practice location
140 Clearview Estates Dr
Newnan, GA 30265-2429
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program Primary | 390200000X | None listed |
Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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About NPI 1093695215
Jackson Tyler Randolph's National Provider Identifier is 1093695215, issued on Sep 8, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Newnan, GA. The record was last updated on Sep 8, 2025.