Provider Demographics
NPI:1962598912
Name:WARNER, AMY (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 WEST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-486-5000
Mailing Address - Fax:404-588-2624
Practice Address - Street 1:1975 HIGHWAY 54 WEST
Practice Address - Street 2:SUITE 150
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-486-5000
Practice Address - Fax:404-588-2624
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030559207R00000X
VA0101280212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF67467Medicare UPIN
GA11BDKRCMedicare PIN