Provider Demographics
NPI:1104099936
Name:WARREN, WARD RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:WARD
Middle Name:RANDALL
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9407
Mailing Address - Country:US
Mailing Address - Phone:706-496-8841
Mailing Address - Fax:
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:C/O EMERGENCY DEPARTMENT UNIVERSITY HOSPITAL
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-774-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088702207P00000X
GA063045207P00000X
METD091110207P00000X
TXP2080207P00000X
SC33294207P00000X
FLME 109750207P00000X
MDD0071741207P00000X
NC169289207P00000X
MO2012007898207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine