MEDICARE: TOMMIE ALBERT WARNER

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	172A00000X	Driver

General Provider Information

NPI Number	:	1982534749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMIE ALBERT WARNER

Provider Business Mailing Address
First Line	:	4323 N 23RD AVE APT 7
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4509
Country	:	US
Telephone Number	:	504-417-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 N 23RD AVE APT 7
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4509
Country	:	US
Telephone Number	:	504-417-6061
Fax Number	:

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

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “ TOMMIE ALBERT WARNER ” Practice Location

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