| Doctor Name: | DR. WARREN STUART THEIS |
| NPI Number: | 1588658702 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101237160 |
| Business Practice Address: | 1405 Alice St Waycross, GA - 315014528 |
| Business Phone Number: | 9122858822 |
| Business Fax Number: | 9122858898 |
| Mailing Address: | 1405 Alice St, WAYCROSS |
| State: | GA |
| Postal Code: | 315014528 |
| Phone Number: | 9122858822 |
| Fax Number: | 9122858898 |
| NPI Enumeration Date: | 09/02/2005 |
| NPI Last Update Date: | 06/03/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101237160 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |