Provider Demographics
NPI:1336335835
Name:WARSY, AMBREEN ADIL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBREEN
Middle Name:ADIL
Last Name:WARSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2191
Mailing Address - Country:US
Mailing Address - Phone:423-952-8000
Mailing Address - Fax:423-952-8001
Practice Address - Street 1:1021 W OAKLAND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2191
Practice Address - Country:US
Practice Address - Phone:423-952-8000
Practice Address - Fax:423-952-8001
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN42593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4166354OtherBCBST
TN3000770Medicaid
VA1336335835Medicaid
TNP01597439OtherRAILROAD MEDICARE
VA1336335835Medicaid
30007701Medicare PIN