Healthcare Provider Details

I. General information

NPI: 1710900162
Provider Name (Legal Business Name): WINSTON R. JESHURAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOSPITAL DR STE 210
MACON GA
31217-8026
US

IV. Provider business mailing address

310 HOSPITAL DR STE 210
MACON GA
31217-8026
US

V. Phone/Fax

Practice location:
  • Phone: 478-787-6255
  • Fax: 478-812-8700
Mailing address:
  • Phone: 478-787-6255
  • Fax: 478-812-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number59432
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD64605
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: