Provider Demographics
NPI:1073577060
Name:WARREN, JOHN FRANK III (PHD, PA-C)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANK
Last Name:WARREN
Suffix:III
Gender:M
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2502
Mailing Address - Country:US
Mailing Address - Phone:336-773-0900
Mailing Address - Fax:336-773-0097
Practice Address - Street 1:840 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2502
Practice Address - Country:US
Practice Address - Phone:336-773-0900
Practice Address - Fax:336-773-0097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC871103T00000X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant