| The Neuropsychiatric Clinic Of Atlantis-villa Rica, P.c. | |
|
560 Thorton Road Ste 120 Lithia Springs GA 30122 | |
| (678) 945-4211 | |
| (678) 945-4221 |
| Full Name | The Neuropsychiatric Clinic Of Atlantis-villa Rica, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 560 Thorton Road, Lithia Springs, Georgia |
| Authorized Official Name and Position | Randy T. Warner (OWNER/CEO) |
| Authorized Official Contact | 6788408446 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Neuropsychiatric Clinic Of Atlantis-villa Rica, P.c. 690 Dallas Highway Ste 201 Villa Rica GA 30180 Ph: (678) 840-8446 | The Neuropsychiatric Clinic Of Atlantis-villa Rica, P.c. 560 Thorton Road Ste 120 Lithia Springs GA 30122 Ph: (678) 945-4211 |
| NPI Number | 1598718512 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 02/25/2019 |
| Medicare PECOS PAC ID | 6507817467 |
|---|---|
| Medicare Enrollment ID | O20050208000715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598718512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 053905 (Georgia) | Primary |
| Provider Name | Randy Warner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144380056 PECOS PAC ID: 5294712279 Enrollment ID: I20050209000493 |
| Provider Name | Keidra Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518724236 PECOS PAC ID: 5890227763 Enrollment ID: I20250129002754 |
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