Provider Demographics
NPI:1083614044
Name:LANGWORTHY, WARREN O (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:O
Last Name:LANGWORTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440163
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0163
Mailing Address - Country:US
Mailing Address - Phone:615-848-2900
Mailing Address - Fax:615-848-2956
Practice Address - Street 1:237 W NORTHFIELD BLVD
Practice Address - Street 2:STE 101
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0531
Practice Address - Country:US
Practice Address - Phone:615-848-2900
Practice Address - Fax:615-848-2956
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3045803Medicaid
TN3045803Medicare ID - Type Unspecified
TN3045803Medicaid