MEDICARE: WINGARD PRIMARY CARE, LLC

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	207Q00000X	Family Medicine Physician
2	261QP2300X	Primary Care Clinic/Center	056526	GA
3	207Q00000X	Family Medicine Physician		GA

General Provider Information

NPI Number	:	1326387820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINGARD PRIMARY CARE, LLC

Provider Business Mailing Address
First Line	:	1325 COMMERCE DR STE 200
Second Line	:	SUITE 200
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3582
Country	:	US
Telephone Number	:	770-692-7575
Fax Number	:	770-692-7570

Provider Business Practice Location Address
First Line	:	1325 COMMERCE DR STE 200
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3582
Country	:	US
Telephone Number	:	770-692-7575
Fax Number	:	770-692-7570

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. RAY BURNETT BENNETT
Credential	:
Telephone Number	:	770-692-7575

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	09/30/2025

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Directions to “WINGARD PRIMARY CARE, LLC ” Practice Location

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