Healthcare Provider Details

I. General information

NPI: 1336388024
Provider Name (Legal Business Name): WARREN W BURNHAM L.M.S.W., D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 WHEELER RD SUITE 210
AUGUSTA GA
30909-6549
US

IV. Provider business mailing address

3633 WHEELER RD SUITE 210
AUGUSTA GA
30909-6549
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-0563
  • Fax: 706-855-0924
Mailing address:
  • Phone: 706-855-0563
  • Fax: 706-855-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMSW000689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: