Provider Demographics
NPI:1093911992
Name:WARREN, JOHN MARLIN (CNMT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARLIN
Last Name:WARREN
Suffix:
Gender:M
Credentials:CNMT
Other - Prefix:
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Mailing Address - Street 1:1145 FAIRWOOD CLOSE NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4689
Mailing Address - Country:US
Mailing Address - Phone:678-384-1711
Mailing Address - Fax:678-229-3401
Practice Address - Street 1:5604 WENDY BAGWELL PKWY
Practice Address - Street 2:SUITE 911
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7809
Practice Address - Country:US
Practice Address - Phone:678-384-1711
Practice Address - Fax:678-384-1721
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0076522471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA007652OtherNMTCB