Healthcare Provider Details

I. General information

NPI: 1285879627
Provider Name (Legal Business Name): CHRISTIE WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 12TH ST
COLUMBUS GA
31901-2522
US

IV. Provider business mailing address

6436 MICHAEL AVE
COLUMBUS GA
31909-3864
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-7776
  • Fax: 706-494-7072
Mailing address:
  • Phone: 706-562-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: