Provider Demographics
NPI:1598718512
Name:THE NEUROPSYCHIATRIC CLINIC OF ATLANTIS-VILLA RICA, P.C.
Entity Type:Organization
Organization Name:THE NEUROPSYCHIATRIC CLINIC OF ATLANTIS-VILLA RICA, P.C.
Other - Org Name:RANDY T. WARNER, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-840-8446
Mailing Address - Street 1:690 DALLAS HIGHWAY
Mailing Address - Street 2:STE 201
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180
Mailing Address - Country:US
Mailing Address - Phone:678-840-8446
Mailing Address - Fax:678-840-8482
Practice Address - Street 1:560 THORTON ROAD
Practice Address - Street 2:STE 120
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122
Practice Address - Country:US
Practice Address - Phone:678-945-4211
Practice Address - Fax:678-945-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0539052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty