Healthcare Provider Details

I. General information

NPI: 1083614044
Provider Name (Legal Business Name): WARREN O LANGWORTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W NORTHFIELD BLVD STE 101
MURFREESBORO TN
37129-0531
US

IV. Provider business mailing address

PO BOX 440163
NASHVILLE TN
37244-0163
US

V. Phone/Fax

Practice location:
  • Phone: 615-848-2900
  • Fax: 615-848-2956
Mailing address:
  • Phone: 615-848-2900
  • Fax: 615-848-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19610
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: