Provider Demographics
NPI:1245289305
Name:WARR, ALSTON GRAHAM (MD)
Entity type:Individual
Prefix:
First Name:ALSTON
Middle Name:GRAHAM
Last Name:WARR
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:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7715 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-328-6031
Practice Address - Fax:901-328-6035
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26874207RA0000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4156349OtherBLUE CROSS OF TENNESSEE
TN3370350OtherMEDICARE GROUP #
TNP00418182OtherRR MEDICARE
TN3370350OtherMEDICARE GROUP #
TN38156331Medicare PIN
TN1245289305Medicare UPIN