Healthcare Provider Details

I. General information

NPI: 1861697740
Provider Name (Legal Business Name): MICHAEL COURTNEY WINDHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ACADEMY AVE
GREENWOOD SC
29646-3808
US

IV. Provider business mailing address

1980 FRIENDSHIP RD STE 104
HOSCHTON GA
30548-4154
US

V. Phone/Fax

Practice location:
  • Phone: 864-223-8090
  • Fax:
Mailing address:
  • Phone: 678-987-1480
  • Fax: 678-987-1481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD039917
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101252282
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46491
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number72729
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME142085
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number82452
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: