Provider Demographics
NPI:1649364779
Name:WARREN, MARJORIE J (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:J
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 1:155 EAGLES WALK
Mailing Address - Street 2:STE F
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6342
Mailing Address - Country:US
Mailing Address - Phone:770-389-8100
Mailing Address - Fax:770-389-3030
Practice Address - Street 1:155 EAGLES WALK
Practice Address - Street 2:STE F
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6342
Practice Address - Country:US
Practice Address - Phone:770-389-8100
Practice Address - Fax:770-389-3030
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0337452084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDHRKMedicare ID - Type Unspecified
GAE50695Medicare UPIN