MEDICARE: DR. CYNTHIA A WILLINGHAM MD

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	208100000X	Physical Medicine & Rehabilitation Physician	ME160482	FL

General Provider Information

NPI Number	:	1134171895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA A WILLINGHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 1164
Second Line	:
City	:	FAYETTEVILLE
State	:	TN
Zip	:	37334-1164
Country	:	US
Telephone Number	:	931-993-9088
Fax Number	:	931-442-3843

Provider Business Practice Location Address
First Line	:	1730 NE PINE ISLAND RD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-1734
Country	:	US
Telephone Number	:	239-355-2416
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/20/2023

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