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JACKSON TYLER RANDOLPH
NPI 1093695215
Student in an Organized Health Care Education/Training Program in Newnan, GA

Active since September 08, 2025
140 CLEARVIEW ESTATES DR, NEWNAN, GA 30265(770) 883-3064 Get Directions Write a Review

NPPES record last updated: September 8, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jackson Tyler Randolph NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON TYLER RANDOLPH (NPI 1093695215) is an individual student in an organized health care education/training program in Newnan, Georgia and active in the NPI registry since September 2025.

NPPES Registry Identity

NPI1093695215
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACKSON TYLER RANDOLPH
Location Address140 CLEARVIEW ESTATES DRNewnan, GA 30265-2429
Mailing Address140 Clearview Estates DrNewnan, GA 30265-2429
Phone(770) 883-3064
Sole ProprietorNo
Enumeration DateSeptember 8, 2025
NPPES CertifiedSeptember 7, 2025
✔ NPI 1093695215 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
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.
140 CLEARVIEW ESTATES DR, Newnan, GA 30265
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Randolph's NPI number?

The NPI number for Jackson Randolph is 1093695215. It was assigned to this individual provider in the NPPES registry on September 8, 2025.

Where is Jackson Randolph located?

Jackson Randolph practices at 140 Clearview Estates Dr, Newnan, GA 30265. The listed phone number is (770) 883-3064.

What is Jackson Randolph's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Jackson Randolph was last updated on September 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.