Healthcare Provider Details

I. General information

NPI: 1831142546
Provider Name (Legal Business Name): WINSTON RAMOS PINEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL DRIVE SUITE 705
LAGRANGE GA
30240-4130
US

IV. Provider business mailing address

300 MEDICAL DRIVE SUITE 705
LAGRANGE GA
30240-4130
US

V. Phone/Fax

Practice location:
  • Phone: 706-885-0111
  • Fax: 706-885-0607
Mailing address:
  • Phone: 706-885-0111
  • Fax: 706-885-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number056906
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: