Provider Demographics
NPI:1477578375
Name:TRAWICK, JAMIKA WARREN (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAMIKA
Middle Name:WARREN
Last Name:TRAWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIKA
Other - Middle Name:WYKITA
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2565 JOLLY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3103
Mailing Address - Country:US
Mailing Address - Phone:404-765-9437
Mailing Address - Fax:404-669-9347
Practice Address - Street 1:2565 JOLLY RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3103
Practice Address - Country:US
Practice Address - Phone:404-765-9437
Practice Address - Fax:404-669-9347
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21660208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0107371001Medicaid
GA577573746CMedicaid
WV0107371001Medicaid