Provider Demographics
NPI:1851330567
Name:WARHAFTIG, JEFFREY LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:WARHAFTIG
Suffix:
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5145 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2207
Practice Address - Country:US
Practice Address - Phone:910-662-6000
Practice Address - Fax:910-792-0160
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851330567Medicaid
NC8911892Medicaid
NC8911892Medicaid
G88257Medicare UPIN
NC2264396BMedicare PIN
NC1851330567Medicaid
NC110216707Medicare PIN