Healthcare Provider Details

I. General information

NPI: 1598718512
Provider Name (Legal Business Name): THE NEUROPSYCHIATRIC CLINIC OF ATLANTIS-VILLA RICA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 THORTON ROAD STE 120
LITHIA SPRINGS GA
30122
US

IV. Provider business mailing address

690 DALLAS HIGHWAY STE 201
VILLA RICA GA
30180
US

V. Phone/Fax

Practice location:
  • Phone: 678-945-4211
  • Fax: 678-945-4221
Mailing address:
  • Phone: 678-840-8446
  • Fax: 678-840-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number053905
License Number StateGA

VIII. Authorized Official

Name: DR. RANDY T. WARNER
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 678-840-8446