Provider Demographics
NPI:1831308139
Name:GARDNER, WARREN EWING II (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:EWING
Last Name:GARDNER
Suffix:II
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 1:975 E. THIRD STREET
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403
Mailing Address - Country:US
Mailing Address - Phone:423-778-5630
Mailing Address - Fax:423-778-3143
Practice Address - Street 1:975 EAST THIRD STREET
Practice Address - Street 2:SUITE C-225
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-5995
Practice Address - Fax:423-778-5994
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44975207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery