Healthcare Provider Details

I. General information

NPI: 1275577520
Provider Name (Legal Business Name): KEVIN WINDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 STEPHENSON AVE
SAVANNAH GA
31405
US

IV. Provider business mailing address

635 STEPHENSON AVE
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-2921
  • Fax: 912-352-1038
Mailing address:
  • Phone: 912-352-2921
  • Fax: 912-352-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberGA042145
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000881174A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: