Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD16862 | TN |
NPI | 1033102629 |
---|---|
Provider Name | Charles Winters JR. |
First Address | Madison, TN 37115-4160 |
Second Address | Madison, TN 37115-4160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 17/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3018804 | (05) | TN |
C46931 | (02) | TN |