Healthcare Provider Details

I. General information

NPI: 1902013709
Provider Name (Legal Business Name): WINSHIP CLINIC,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BROOKSTONE CENTRE PKWY BLDG. 200
COLUMBUS GA
31904-4501
US

IV. Provider business mailing address

PO BOX 102748
ATLANTA GA
30368-2748
US

V. Phone/Fax

Practice location:
  • Phone: 706-256-0700
  • Fax: 866-390-9155
Mailing address:
  • Phone: 706-256-0700
  • Fax: 866-390-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number040477
License Number StateGA

VIII. Authorized Official

Name: DR. ELIZABETH M MARTIN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 706-256-0700