NPIMap

Organization Active NPI

The Neuropsychiatric Clinic of Atlantis-Villa Rica, P.C.

  • Psychiatry Physician
  • Lithia Springs, GA
National Provider Identifier
1598718512
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
053905 Issued in GA
Legal business name
THE NEUROPSYCHIATRIC CLINIC OF ATLANTIS-VILLA RICA, P.C.
Practice address
560 Thorton Road
Ste 120
Lithia Springs, GA 30122
Phone
(678) 945-4211
Fax
(678) 945-4221
NPI assigned
May 19, 2006
Last updated
Feb 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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

Authorized official

Name
Dr. Randy T. Warner, M.D.NPI 1144380056
Title
Owner/Ceo
Phone
(678) 840-8446

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 053905 GA Primary

Addresses

Primary practice location

560 Thorton Road
Ste 120
Lithia Springs, GA 30122

Mailing address

690 Dallas Highway
Ste 201
Villa Rica, GA 30180
Phone (678) 840-8446

Other names 1

  • Randy T. Warner, M.D. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050208000715 GA Part B Supplier - Clinic/Group Practice 6507817467 Receives reassigned benefits from 2 practitioners
Practice locations: Villa Rica, GA

National Provider Directory

National Provider Directory
Tax ID family
The Neuropsychiatric Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

560 Thornton Rd
Ste 120
Lithia Springs, GA 30122
Phone (678) 840-8446

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1598718512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 DALLAS HIGHWAY",
            "address_2": "STE 201",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "30180",
            "telephone_number": "678-840-8446",
            "fax_number": "678-840-8482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 THORTON ROAD",
            "address_2": "STE 120",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "30122",
            "telephone_number": "678-945-4211",
            "fax_number": "678-945-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE NEUROPSYCHIATRIC CLINIC OF ATLANTIS-VILLA RICA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2019-02-25",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "678-840-8446",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "053905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randy T. Warner, M.D.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Randy T. Warner, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lithia Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.