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General NPI Number Information
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NPI Number | 1104099936
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Entity Type | Individual
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Provider Name | WARD RANDALL WARREN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2008
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 1350 WALTON WAY C/O EMERGENCY DEPARTMENT UNIVERSITY HOSPITAL
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City | AUGUSTA
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State | GA
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Zip | 30901-2612
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Country | US
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Telephone | 706-774-5304
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Fax |
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Provider Business Mailing Address
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Address Line | 3709 W LAKE DR
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City | MARTINEZ
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State | GA
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Zip | 30907-9407
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Country | US
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Telephone | 706-496-8841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301088702
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 063045
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | TD091110
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | P2080
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 33294
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME 109750
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | D0071741
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License Number State | MD
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Taxonomy #8
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 169289
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License Number State | NC
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Taxonomy #9
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2012007898
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License Number State | MO
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