| Kenneth R. W. Warren, M.d.p.c. | |
|
31 Physicians Dr Jackson TN 38305-2071 | |
| (731) 664-0103 | |
| (731) 664-5666 |
| Full Name | Kenneth R. W. Warren, M.d.p.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 31 Physicians Dr, Jackson, Tennessee |
| Authorized Official Name and Position | Kenneth Russell Warren (PRESIDENT) |
| Authorized Official Contact | 7316640103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth R. W. Warren, M.d.p.c. 31 Physicians Dr Jackson TN 38305-2071 Ph: (731) 664-0103 | Kenneth R. W. Warren, M.d.p.c. 31 Physicians Dr Jackson TN 38305-2071 Ph: (731) 664-0103 |
| NPI Number | 1518169812 |
|---|---|
| Provider Enumeration Date | 05/31/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518169812 | NPI | - | NPPES |
| 3168937 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0000011892 (Tennessee) | Primary |
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