Kevin Richard Wandler, MD

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

92660 Issued in GA

Practice address

11725 Pointe PL
Roswell, GA 30076-4636

Phone

(470) 990-9483

Fax

(877) 800-5436

NPI assigned

Mar 30, 2007

Last updated

Jan 8, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 10

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Florida Detox, LLC

  dba Orlando Recovery Center

  • Psychiatric Residential Treatment Facility
  • Orlando, FL
  • NPI 1073909560

  Substance Abuse Rehabilitation Facility

  NPD (past)
• Pacific North Recovery Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Ridgefield, WA
  • NPI 1669837449
  NPD (past)
• Recovery Village at Palmer Lake, LLC

  dba Denver Mental Health and Counseling by The Recovery Village

  • Mental Illness Community Based Residential Treatment Facility
  • Highlands Ranch, CO
  • NPI 1124830245
  NPD (past)
• Recovery Village at Palmer Lake, LLC

  • Substance Abuse Rehabilitation Facility
  • Palmer Lake, CO
  • NPI 1356738132
  NPD (past)
• The Recovery Village at Umatilla

  • Psychiatric Residential Treatment Facility
  • Umatilla, FL
  • NPI 1760729669

  Substance Abuse Rehabilitation Facility

  NPD (past)
• The Recovery Village Indiana, LLC

  dba The Recovery Village Indianapolis

  • Substance Abuse Rehabilitation Facility
  • Indianapolis, IN
  • NPI 1497524730
  NPD (past)
• The Treatment Center by the Recovery Village, LLC

  dba The Recovery Village Miami at Baptist Health

  • Psychiatric Residential Treatment Facility
  • Lake Worth, FL
  • NPI 1164907366

  Substance Abuse Rehabilitation Facility

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1205956265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 S HILLHURST RD",
            "city": "RIDGEFIELD",
            "state": "WA",
            "postal_code": "986429063",
            "telephone_number": "754-300-3120",
            "fax_number": "954-306-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11725 POINTE PL",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764636",
            "telephone_number": "470-990-9483",
            "fax_number": "877-800-5436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8150 Brookville Rd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462398903",
            "country_code": "US",
            "telephone_number": "317-754-7784",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "888 S Hillhurst Rd",
            "address_purpose": "LOCATION",
            "city": "Ridgefield",
            "state": "WA",
            "postal_code": "986429063",
            "country_code": "US",
            "telephone_number": "754-300-3120 x4118",
            "fax_number": "954-306-8977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANDLER",
        "first_name": "KEVIN",
        "middle_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "CO",
            "license": "DR.0055465",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "OH",
            "license": "130525",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "MO",
            "license": "2022048625",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "WA",
            "license": "MD60562814",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "IN",
            "license": "01092373A",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NJ",
            "license": "25MA10809300",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "GA",
            "license": "92660",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "14421",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME110716",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "NJ",
            "license": "25MA10809300",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004007100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harriet Wall, LPC
• Parris Mikayla Waller
• Shannon Burge Wallon, LPC, NCC
• Steven Michael Walsh, MD
• Anna Walter, RBT
• Hui Wang, AP, MD FROM CHINA
• Jie Wang, ACUPUNCTURIST
• Cassandra L Wanzo, MD
• Andrew Ward, PH.D.
• Cynthia Maynard Ward, PSYD

• Addiction Medicine (Psychiatry & Neurology) Physician in Roswell, GA
• Providers in Roswell, GA by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.