Healthcare Provider Details

I. General information

NPI: 1043273014
Provider Name (Legal Business Name): WILLIE M WINZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COLLIER RD NW STE 635
ATLANTA GA
30309-1611
US

IV. Provider business mailing address

35 COLLIER RD NW STE 635
ATLANTA GA
30309-1611
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax:
Mailing address:
  • Phone: 404-367-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number031365
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number031365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: