Healthcare Provider Details

I. General information

NPI: 1225056872
Provider Name (Legal Business Name): JEFFERY STEVEN WARREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N HIGHLAND ST
MEMPHIS TN
38111-4747
US

IV. Provider business mailing address

PO BOX 197593
NASHVILLE TN
37219-7593
US

V. Phone/Fax

Practice location:
  • Phone: 901-844-2500
  • Fax: 901-844-1439
Mailing address:
  • Phone: 901-844-2500
  • Fax: 901-844-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19075
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: