MEDICARE: KYLE CHRISTOPHER WARREN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	86705	GA
2	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1407415961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE CHRISTOPHER WARREN MD

Provider Business Mailing Address
First Line	:	6600 VAN AALST BLVD
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 VAN AALST BLVD
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:	762-408-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	04/20/2026

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