Provider Demographics
NPI:1851345904
Name:WARREN, WILLIAM C IV (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:WARREN
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:CHESTER
Other - Last Name:WARREN
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:239 IVAN ALLEN JR BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313
Mailing Address - Country:US
Mailing Address - Phone:404-523-6571
Mailing Address - Fax:404-523-6574
Practice Address - Street 1:239 IVAN ALLEN JR BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313
Practice Address - Country:US
Practice Address - Phone:404-523-6571
Practice Address - Fax:404-523-6574
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D41330Medicare UPIN