Provider Demographics
NPI:1487763991
Name:HARTLINE, RANDAL GARNETT (MD)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:GARNETT
Last Name:HARTLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4138
Mailing Address - Country:US
Mailing Address - Phone:865-567-4990
Mailing Address - Fax:615-893-0442
Practice Address - Street 1:726 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4933
Practice Address - Country:US
Practice Address - Phone:615-893-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000018862207V00000X, 207VG0400X
TNMD18862207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD0000018862OtherMEDICAL LICENSE
TN3034792Medicaid
3034792Medicare ID - Type Unspecified