Provider Demographics
NPI:1780318832
Name:WARWICK-DAVIS, CHARIS RE'NEE (THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:CHARIS
Middle Name:RE'NEE
Last Name:WARWICK-DAVIS
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 QUARTZ DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-3256
Mailing Address - Country:US
Mailing Address - Phone:678-333-4550
Mailing Address - Fax:770-812-3805
Practice Address - Street 1:101 QUARTZ DR STE 201
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3256
Practice Address - Country:US
Practice Address - Phone:678-333-4550
Practice Address - Fax:770-812-3805
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16992OtherN/A