Healthcare Provider Details

I. General information

NPI: 1225969975
Provider Name (Legal Business Name): WARREN SCOTHORN CHAI BERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

515 MOODY CT APT 107
AUGUSTA GA
30907-7340
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN300258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: