Healthcare Provider Details

I. General information

NPI: 1982534749
Provider Name (Legal Business Name): TOMMIE ALBERT WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 N 23RD AVE APT 7
PHOENIX AZ
85015-4509
US

IV. Provider business mailing address

4323 N 23RD AVE APT 7
PHOENIX AZ
85015-4509
US

V. Phone/Fax

Practice location:
  • Phone: 504-417-6061
  • Fax:
Mailing address:
  • Phone: 504-417-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: