Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 18274 | TN |
N | 207ND0101X | MOHS-Micrographic Surgeon | 18274 | TN |
N | 207NS0135X | Procedural Dermatology | 18274 | TN |
NPI | 1447253653 |
---|---|
Provider Name | George Beverly Winton |
First Address | Johnson City, TN 37604-3693 |
Second Address | Johnson City, TN 37604-3693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 22/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3031272 | (05) | TN |
C87235 | (02) | |
C87235 | (02) | TN |