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General NPI Number Information
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NPI Number | 1871770412
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Entity Type | Individual
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Provider Name | ALBERT WARREN JR. MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 1339 GRAY HWY
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City | MACON
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State | GA
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Zip | 31211-1903
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Country | US
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Telephone | 478-749-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 BOULDER DR
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City | GRAY
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State | GA
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Zip | 31032-6149
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Country | US
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Telephone | 478-607-0400
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 063748
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License Number State | GA
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