Healthcare Provider Details

I. General information

NPI: 1568409456
Provider Name (Legal Business Name): DOUGLAS E. WINESETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR SUITE A140
GREENVILLE SC
29615-3593
US

IV. Provider business mailing address

7 INDEPENDENCE PT SUITE 140
GREENVILLE SC
29615-4566
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-5125
  • Fax: 864-454-5131
Mailing address:
  • Phone: 864-797-6044
  • Fax: 864-797-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number23568
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: