Provider Demographics
NPI:1467563734
Name:WARREN, ELBERT G III (MD)
Entity Type:Individual
Prefix:DR
First Name:ELBERT
Middle Name:G
Last Name:WARREN
Suffix:III
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 248
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0248
Mailing Address - Country:US
Mailing Address - Phone:931-766-4560
Mailing Address - Fax:931-766-4568
Practice Address - Street 1:1605 S LOCUST AVE
Practice Address - Street 2:STE 200
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4061
Practice Address - Country:US
Practice Address - Phone:931-766-4560
Practice Address - Fax:931-766-4568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36295207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4321647OtherBCBS TN
TN3872835Medicaid
01621746OtherAMERIGROUP
01621746OtherAMERIGROUP
TN3872835Medicaid
TN103I165439Medicare PIN