Individual
DR. WARREN DIBRELL ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4350 TOWNE CENTRE DR, SUITE 1000, EVANS, GA 30809-3301
(706) 868-3940
Mailing address
1125 TROUPE ST, P. O. BOX 3845, AUGUSTA, GA 30914-3845
(706) 737-4575
(706) 731-5289
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
027989
GA
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
027989
GA
2085N0700X
Neuroradiology Physician
027989
GA
2085N0904X
Nuclear Radiology Physician
027989
GA
2085P0229X
Pediatric Radiology Physician
027989
GA
2085R0202X
Diagnostic Radiology Physician
Primary
027989
GA
2085U0001X
Diagnostic Ultrasound Physician
027989
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00344121B
—
GA
05
—
00344121D
—
GA
05
—
00344121E
—
GA
05
—
00344121F
—
GA
05
—
00344121H
—
GA
05
—
00344121I
—
GA
05
—
00344121J
—
GA
05
—
00344121L
—
GA
05
—
00344121M
—
GA
05
—
00344121N
—
GA
01
—
10058441
AMERIGROUP
—
01
—
1265540314
NPI - BROWN & RADIOLOGY
—
05
—
G27989
—
SC
Enumeration date
04/14/2006
Last updated
10/31/2013
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