Provider Demographics
NPI:1649459421
Name:JEFFREY B. WARREN, M.D. AND ASSOCIATES, P.C.
Entity type:Organization
Organization Name:JEFFREY B. WARREN, M.D. AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-642-7802
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-0190
Mailing Address - Country:US
Mailing Address - Phone:731-642-7802
Mailing Address - Fax:731-642-7804
Practice Address - Street 1:1027 MINERAL WELLS AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4905
Practice Address - Country:US
Practice Address - Phone:731-642-7802
Practice Address - Fax:731-642-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0377232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE90344Medicare UPIN