Healthcare Provider Details

I. General information

NPI: 1902416035
Provider Name (Legal Business Name): COURTNEY TAYLOR WARFEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 JENNINGS MILL RD STE 110
WATKINSVILLE GA
30677-7241
US

IV. Provider business mailing address

4561 TRICKUM RD NE
MARIETTA GA
30066-1364
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-5880
  • Fax:
Mailing address:
  • Phone: 170-620-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1173282
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: