Provider Demographics
NPI:1164567277
Name:WINER, RICHARD STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEVEN
Last Name:WINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11685 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4913
Mailing Address - Country:US
Mailing Address - Phone:770-442-1150
Mailing Address - Fax:770-772-0416
Practice Address - Street 1:11685 ALPHARETTA HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4913
Practice Address - Country:US
Practice Address - Phone:770-442-1150
Practice Address - Fax:770-772-0416
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0264122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00290804BMedicaid
GA00290804BMedicaid
GA26BDCRLMedicare ID - Type Unspecified