MEDICARE: LLOYD THOMAS WINGER IV 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	208600000X	Surgery Physician	051859	GA

General Provider Information

NPI Number	:	1457350894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD THOMAS WINGER IV MD

Provider Business Mailing Address
First Line	:	1265 HIGHWAY 54 W STE 500B
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4556
Country	:	US
Telephone Number	:	770-719-5660
Fax Number	:	678-817-4339

Provider Business Practice Location Address
First Line	:	1265 HIGHWAY 54 W
Second Line	:	SUITE 500B
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4548
Country	:	US
Telephone Number	:	770-719-5660
Fax Number	:	678-817-4339

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/23/2019

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