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General NPI Number Information
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NPI Number | 1912108796
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Entity Type | Individual
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Provider Name | WARREN ROGER THOMAS D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 135 RUSSELL HILL ESTATES DRIVE. NW
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City | SUGAR VALLEY
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State | GA
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Zip | 30746
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Country | US
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Telephone | 706-624-0552
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Fax | 706-624-0552
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Provider Business Mailing Address
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Address Line | 135 RUSSELL HILL ESTATES DRIVE. NW
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City | SUGAR VALLEY
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State | GA
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Zip | 30746
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Country | US
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Telephone | 706-624-0552
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Fax | 706-624-0552
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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 | 046567
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License Number State | GA
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