Healthcare Provider Details

I. General information

NPI: 1811387053
Provider Name (Legal Business Name): ERIC M WARG RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MAIN ST 24
DOTHAN AL
36305-1054
US

IV. Provider business mailing address

4300 W MAIN ST 24
DOTHAN AL
36305-1054
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-1534
  • Fax:
Mailing address:
  • Phone: 334-793-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1-091298
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: