Healthcare Provider Details

I. General information

NPI: 1326459579
Provider Name (Legal Business Name): JON VICTOR WARKENTIN M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TENNESSEE DEPT OFHEALTH 710 JAMES ROBERTSON PKWY., 3RD FLOOR AJT
NASHVILLE TN
37243-0001
US

IV. Provider business mailing address

TENNESSEE DEPT OFHEALTH 710 JAMES ROBERTSON PKWY., 3RD FLOOR AJT
NASHVILLE TN
37243-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-253-1364
  • Fax: 615-253-1370
Mailing address:
  • Phone: 615-253-1364
  • Fax: 615-253-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD34227
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: