Provider Demographics
NPI:1184464331
Name:WARREN, TIYRONE
Entity type:Individual
Prefix:DR
First Name:TIYRONE
Middle Name:
Last Name:WARREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PARK AVENUE WEST NW UNIT 903
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1607
Mailing Address - Country:US
Mailing Address - Phone:323-270-2165
Mailing Address - Fax:
Practice Address - Street 1:4595 PADDOCK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1131
Practice Address - Country:US
Practice Address - Phone:323-312-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist
No372600000XNursing Service Related ProvidersAdult Companion