Organization
KENNETH R. W. WARREN, M.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH RUSSELL WARREN M.D. (PRESIDENT)
(731) 664-0103
Entity
Organization
Contact information
Practice address
31 PHYSICIANS DR, JACKSON, TN 38305-2071
(731) 664-0103
(731) 664-5666
Mailing address
31 PHYSICIANS DR, JACKSON, TN 38305-2071
(731) 664-0103
(731) 664-5666
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0000011892
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3168937
—
TN
Enumeration date
05/31/2007
Last updated
08/22/2020
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