MEDICARE: JAMES DARRAH WARREN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1851154579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DARRAH WARREN

Provider Business Mailing Address
First Line	:	1435 ROBERT DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-6339
Country	:	US
Telephone Number	:	228-669-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 ROBERT DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-6339
Country	:	US
Telephone Number	:	601-984-5012
Fax Number	:

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	04/02/2025

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