1821080342 NPI number — DEBRA JEININE WARE MD

Table of content: (NPI 1841257599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821080342 NPI number — DEBRA JEININE WARE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARE
Provider First Name:
DEBRA
Provider Middle Name:
JEININE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1821080342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1348 WALTON WAY STE 6200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30901-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-724-0060
Provider Business Mailing Address Fax Number:
706-724-0062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1348 WALTON WAY
Provider Second Line Business Practice Location Address:
SUITE 5500
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-872-4214
Provider Business Practice Location Address Fax Number:
706-724-1908
Provider Enumeration Date:
08/19/2005

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: 207V00000X , with the licence number:  036476 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 036476 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00517173A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G08345 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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