MEDICARE: CHARLES JOSEPH WINTERS M.D.

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	11968	MS
2	207X00000X	Orthopaedic Surgery Physician	11968	MS

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

General Provider Information

NPI Number	:	1093733172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES JOSEPH WINTERS M.D.

Provider Business Mailing Address
First Line	:	6300 E LAKE BLVD STE 301
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-6771
Country	:	US
Telephone Number	:	228-230-2663
Fax Number	:	228-206-3424

Provider Business Practice Location Address
First Line	:	6300 E LAKE BLVD STE 201
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-6771
Country	:	US
Telephone Number	:	228-230-2663
Fax Number	:	228-546-3257

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/25/2021

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Directions to “ CHARLES JOSEPH WINTERS M.D.” Practice Location

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