Healthcare Provider Details

I. General information

NPI: 1336367580
Provider Name (Legal Business Name): JOHN FREDRICK WINNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 GREEN ST. NE
GAINESVILLE GA
30501
US

IV. Provider business mailing address

3980 SUNDOWN DR
GAINESVILLE GA
30506-3604
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-6600
  • Fax: 770-536-3923
Mailing address:
  • Phone: 770-536-2000
  • Fax: 770-536-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO01963
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: