Provider Demographics
NPI:1316060601
Name:WARREN, JAMES D (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:WARREN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 RIVOLI OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1595
Mailing Address - Country:US
Mailing Address - Phone:478-471-1736
Mailing Address - Fax:
Practice Address - Street 1:4160 RIGGINS MILL RD
Practice Address - Street 2:MACON YDC
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-5440
Practice Address - Country:US
Practice Address - Phone:478-751-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001150103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent