Provider Demographics
NPI:1295727527
Name:WARREN, FELICITY M (MD)
Entity type:Individual
Prefix:
First Name:FELICITY
Middle Name:M
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 LAWRENCEVILLE HWY NW STE 110
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2831
Mailing Address - Country:US
Mailing Address - Phone:770-852-5552
Mailing Address - Fax:770-852-5553
Practice Address - Street 1:3993 LAWRENCEVILLE HWY NW STE 110
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2831
Practice Address - Country:US
Practice Address - Phone:770-852-5552
Practice Address - Fax:770-852-5553
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034978207N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA07BBSHQ01Medicare PIN
GAE94098Medicare UPIN
GA07BBSHQ02Medicare PIN
GA07BBSHQMedicare ID - Type Unspecified