=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932134871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON R WINTER DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 11/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 HOSPITAL DR
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38320-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-584-3141
-----------------------------------------------------
Fax | 731-584-3143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 HOSPITAL DR
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38320-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-584-3141
-----------------------------------------------------
Fax | 731-584-3143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 824
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------