Provider Demographics
NPI:1467436451
Name:WARREN, JAMES E JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:WARREN
Suffix:JR
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 1:15 CAVENDER ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1931
Mailing Address - Country:US
Mailing Address - Phone:770-254-6150
Mailing Address - Fax:770-254-6181
Practice Address - Street 1:15 CAVENDER ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1931
Practice Address - Country:US
Practice Address - Phone:770-254-6150
Practice Address - Fax:770-254-6181
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00360093BMedicaid
GA11BDCSTMedicare ID - Type Unspecified
GAD42089Medicare UPIN