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General NPI Number Information
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NPI Number | 1568425551
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Entity Type | Organization
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Legal Business Name | WILLIE M. WINZER MD PC
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6524 PROFESSIONAL PL
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City | RIVERDALE
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State | GA
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Zip | 30274-2520
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Country | US
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Telephone | 770-994-4060
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Fax | 770-994-9435
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Provider Business Mailing Address
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Address Line | 6524 PROFESSIONAL PL
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City | RIVERDALE
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State | GA
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Zip | 30274-2520
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Country | US
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Telephone | 770-994-4060
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Fax | 770-994-9435
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIE M WINZER
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Credential | MD
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Telephone | 770-994-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 031365
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License Number State | GA
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