Healthcare Provider Details

I. General information

NPI: 1417064536
Provider Name (Legal Business Name): DIANA W. WARREN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42030 HIGHWAY 195 SUITE C
HALEYVILLE AL
35565
US

IV. Provider business mailing address

PO BOX 880 42030 HIGHWAY 195 SUITE C
HALEYVILLE AL
35565-0880
US

V. Phone/Fax

Practice location:
  • Phone: 205-485-7337
  • Fax: 205-485-7393
Mailing address:
  • Phone: 205-485-7337
  • Fax: 205-485-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberDO523
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO523
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: