Healthcare Provider Details

I. General information

NPI: 1821080342
Provider Name (Legal Business Name): DEBRA JEININE WARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY SUITE 5500
AUGUSTA GA
30901-5104
US

IV. Provider business mailing address

1348 WALTON WAY STE 6200
AUGUSTA GA
30901-5109
US

V. Phone/Fax

Practice location:
  • Phone: 706-872-4214
  • Fax: 706-724-1908
Mailing address:
  • Phone: 706-724-0060
  • Fax: 706-724-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036476
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036476
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: