Provider Demographics
NPI:1932185030
Name:WARRICK, JOHN PAUL JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:WARRICK
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3123
Mailing Address - Country:US
Mailing Address - Phone:706-883-6415
Mailing Address - Fax:706-884-2429
Practice Address - Street 1:411 S GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3123
Practice Address - Country:US
Practice Address - Phone:706-883-6415
Practice Address - Fax:706-884-2429
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000502213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00277648AMedicaid
GA0561260001Medicare NSC
GA00277648AMedicaid