Healthcare Provider Details

I. General information

NPI: 1598754087
Provider Name (Legal Business Name): WARREN FALO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SANDY PLAINS RD
MARIETTA GA
30066-3020
US

IV. Provider business mailing address

3600 SANDY PLAINS RD
MARIETTA GA
30066-3020
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-4547
  • Fax: 770-977-8354
Mailing address:
  • Phone: 770-977-4547
  • Fax: 770-977-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number046680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: