Provider Demographics
NPI:1316504350
Name:WARDEN, JULIA SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:SUZANNE
Last Name:WARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746721
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6721
Mailing Address - Country:US
Mailing Address - Phone:773-352-1515
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:9410 DUGAS DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1870
Practice Address - Country:US
Practice Address - Phone:726-262-7975
Practice Address - Fax:726-262-7976
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD13580207Q00000X
TXT7768207Q00000X
BP10068878390200000X
IL036.171361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program