Basic Information
| Provider Information | |||||||||
| NPI: | 1134348998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WARRENTON FAMILY PRACTICE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 CHRISTMAS RD | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275898723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522570372 | ||||||||
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| Practice Location | |||||||||
| Address1: | 163 CHRISTMAS RD | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275898723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522570372 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 10/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | DOUGLAS-LEWIS | ||||||||
| AuthorizedOfficialFirstName: | YVETTE | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2522570372 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 137051 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.