Provider Demographics
NPI:1629141791
Name:WARD, WARREN MARSHALL (DC)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MARSHALL
Last Name:WARD
Suffix:
Gender:M
Credentials:DC
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 541
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0541
Mailing Address - Country:US
Mailing Address - Phone:912-764-6100
Mailing Address - Fax:912-489-2961
Practice Address - Street 1:104 NORTHSIDE DR W
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5301
Practice Address - Country:US
Practice Address - Phone:912-764-6100
Practice Address - Fax:912-489-2961
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR003139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00488452AMedicaid
GA00488452AMedicaid
GAU17868Medicare UPIN