Healthcare Provider Details

I. General information

NPI: 1982989026
Provider Name (Legal Business Name): ROBERT RANDAL WARNOCK R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 RIVERHILL DR
BISHOP GA
30621-6121
US

IV. Provider business mailing address

1060 RIVERHILL DR
BISHOP GA
30621-6121
US

V. Phone/Fax

Practice location:
  • Phone: 770-880-6901
  • Fax: 479-478-2459
Mailing address:
  • Phone: 770-880-6901
  • Fax: 479-478-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number12648
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: