Healthcare Provider Details

I. General information

NPI: 1932019627
Provider Name (Legal Business Name): JULIA WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MIDLAND PKWY
SUMMERVILLE SC
29485-7197
US

IV. Provider business mailing address

309 RESERVE WAY
SUMMERVILLE SC
29485-8662
US

V. Phone/Fax

Practice location:
  • Phone: 484-801-7949
  • Fax:
Mailing address:
  • Phone: 484-801-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: