Provider Demographics
NPI:1821080342
Name:WARE, DEBRA JEININE (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEININE
Last Name:WARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 WALTON WAY STE 6200
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5109
Mailing Address - Country:US
Mailing Address - Phone:706-724-0060
Mailing Address - Fax:706-724-0062
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 5500
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5104
Practice Address - Country:US
Practice Address - Phone:706-872-4214
Practice Address - Fax:706-724-1908
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036476207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00517173AMedicaid
SCG08345Medicaid
GAF39863Medicare UPIN
GA16BDCTVMedicare ID - Type Unspecified