Basic Information
| Provider Information | |||||||||
| NPI: | 1760485486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARNIMONT | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 751803 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367660547 | ||||||||
| FaxNumber: | 3367660549 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 STADIUM OAKS DR | ||||||||
| Address2: | |||||||||
| City: | CLEMMONS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270128962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367660547 | ||||||||
| FaxNumber: | 3367660549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 95-00759 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 95-00759 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 66568863 | 01 | CHAMPUS | OTHER | P00457709 | 01 | NC | RAILROAD MEDICARE | OTHER | 0402116 | 01 | UNITED HEALTHCARE | OTHER | 2624329 | 01 | AETNA HMO OPOS | OTHER | 58459 | 01 | MEDCOST | OTHER | P00165221 | 01 | RAILROAD MEDICARE | OTHER | 8985749 | 05 | NC | MEDICAID | 5296039 | 01 | AETNA PPO POS | OTHER | 8119782 | 01 | MAMSI | OTHER | 85749 | 01 | BCBS | OTHER | 10527 | 01 | PARTNERS | OTHER |