Provider Demographics
NPI:1356360119
Name:WARNOCK, JAMES L JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:WARNOCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:STE 104
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-969-6404
Practice Address - Fax:601-973-4541
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS13570207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125983Medicaid
060068616Medicare PIN
MSF75078Medicare UPIN
MS060000622Medicare ID - Type Unspecified