Provider Demographics
NPI:1306064688
Name:DR. STEVEN R. WARSTADT & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DR. STEVEN R. WARSTADT & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:WARSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-493-9171
Mailing Address - Street 1:4800 BRIARCLIFF RD NE
Mailing Address - Street 2:1173 NORTHLAKE MALL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2743
Mailing Address - Country:US
Mailing Address - Phone:770-493-9171
Mailing Address - Fax:770-493-9297
Practice Address - Street 1:4800 BRIARCLIFF RD NE
Practice Address - Street 2:1173 NORTHLAKE MALL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2743
Practice Address - Country:US
Practice Address - Phone:770-493-9171
Practice Address - Fax:770-493-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41-ZCBNCMedicare ID - Type Unspecified