Healthcare Provider Details

I. General information

NPI: 1396156238
Provider Name (Legal Business Name): ZANNA WYNTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 HARPER ST
AUGUSTA GA
30912-7070
US

IV. Provider business mailing address

1446 HARPER ST
AUGUSTA GA
30912-0012
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2286
  • Fax:
Mailing address:
  • Phone: 706-721-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number079011
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number79011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: