1174584403 NPI number — DR. HARRISON FREDERICK WARNER MD

Table of content: DR. HARRISON FREDERICK WARNER MD (NPI 1174584403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174584403 NPI number — DR. HARRISON FREDERICK WARNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARNER
Provider First Name:
HARRISON
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174584403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2004 HAYES ST # LL30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-2646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-284-7950
Provider Business Mailing Address Fax Number:
615-284-5750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37236-7541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-284-5229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X , with the licence number:  40852 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 23866 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 40852 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23866 . This is a "SC MEDICAL LICENSE #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 009937112 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64116353 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0101058114 . This is a "VA MEDICAL LICENSE#" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1509868 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000037471 . This is a "TLC TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 010335884 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100051008 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4123407 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 187244 . This is a "UNISON TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 200301076 . This is a "NC MEDICAL LICENSE#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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