Healthcare Provider Details

I. General information

NPI: 1205122736
Provider Name (Legal Business Name): PAMELA JAMES WARNER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 RACETRACK RD NW STE C
FORT WALTON BEACH FL
32547-1788
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-8112
  • Fax: 850-362-6068
Mailing address:
  • Phone:
  • Fax: 706-494-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberOS14899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: