Healthcare Provider Details

I. General information

NPI: 1295727527
Provider Name (Legal Business Name): FELICITY M. WARREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3993 LAWRENCEVILLE HWY NW STE 110
LILBURN GA
30047-2831
US

IV. Provider business mailing address

3993 LAWRENCEVILLE HWY NW STE 110
LILBURN GA
30047-2831
US

V. Phone/Fax

Practice location:
  • Phone: 770-852-5552
  • Fax: 770-852-5553
Mailing address:
  • Phone: 770-852-5552
  • Fax: 770-852-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number034978
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number034978
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: