MEDICARE: CHARLES DAVID WINFREY P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA-59	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51532172	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1043220122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES DAVID WINFREY P.A.

Provider Business Mailing Address
First Line	:	1414 ELBA HWY
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36079-6020
Country	:	US
Telephone Number	:	334-670-6726
Fax Number	:	334-670-6731

Provider Business Practice Location Address
First Line	:	193 OATES DR
Second Line	:
City	:	NEWTON
State	:	AL
Zip	:	36352-4312
Country	:	US
Telephone Number	:	334-299-3592
Fax Number	:	334-299-3870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	03/05/2013

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