Basic Information
| Provider Information | |||||||||
| NPI: | 1174584403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARNER | ||||||||
| FirstName: | HARRISON | ||||||||
| MiddleName: | FREDERICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 HAYES ST # LL30 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152847950 | ||||||||
| FaxNumber: | 6152845750 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372367541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152845229 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 40852 | TN | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0102X | 23866 | SC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 40852 | TN | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 23866 | 01 | SC | SC MEDICAL LICENSE # | OTHER | 009937112 | 05 | AL | MEDICAID | 64116353 | 05 | KY | MEDICAID | 0101058114 | 01 | VA | VA MEDICAL LICENSE# | OTHER | 1509868 | 05 | TN | MEDICAID | 000000037471 | 01 | TN | TLC TENNCARE | OTHER | 010335884 | 05 | VA | MEDICAID | 100051008 | 01 | TN | PHP TENNCARE | OTHER | 4123407 | 01 | TN | BLUE CROSS | OTHER | 187244 | 01 | TN | UNISON TENNCARE | OTHER | 200301076 | 01 | NC | NC MEDICAL LICENSE# | OTHER |