Provider Demographics
NPI:1790473031
Name:WARNER, GWEN
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6142
Mailing Address - Country:US
Mailing Address - Phone:404-717-4900
Mailing Address - Fax:
Practice Address - Street 1:519 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6142
Practice Address - Country:US
Practice Address - Phone:404-717-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health