MEDICARE: DR. BARBARA LOUISE GWINN 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	208D00000X	General Practice Physician	01064737A	IN

General Provider Information

NPI Number	:	1558442178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA LOUISE GWINN M.D.

Provider Business Mailing Address
First Line	:	3278 MITCHELL BLVD
Second Line	:
City	:	MOODY A F B
State	:	GA
Zip	:	31699-1500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3278 MITCHELL BLVD
Second Line	:
City	:	MOODY A F B
State	:	GA
Zip	:	31699-1500
Country	:	US
Telephone Number	:	229-257-3165
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/09/2008

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