Healthcare Provider Details

I. General information

NPI: 1568677532
Provider Name (Legal Business Name): WARREN UMANSKY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WHEELER EXECUTIVE CENTER
AUGUSTA GA
30909-1898
US

IV. Provider business mailing address

302 WHEELER EXECUTIVE CENTER
AUGUSTA GA
30909-1898
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-8500
  • Fax: 706-737-0442
Mailing address:
  • Phone: 706-736-8500
  • Fax: 706-737-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: