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NPI Code Detail

MEDICARE: PRESTON D. WINGATE PA-C

MEDICARE: PRESTON D. WINGATE PA-C
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
1363A00000XPhysician AssistantPA174AL

General Provider Information

NPI Number : 1578500260
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRESTON D. WINGATE PA-C
Provider Business Mailing Address
First Line : 5018 CAHABA RIVER RD
Second Line :
City : VESTAVIA
State : AL
Zip : 35243-2317
Country : US
Telephone Number : 53-975-2002
Fax Number :
Provider Business Practice Location Address
First Line : 5018 CAHABA RIVER RD
Second Line :
City : VESTAVIA
State : AL
Zip : 35243-2317
Country : US
Telephone Number : 53-975-2002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 09/01/2020

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Directions to “ PRESTON D. WINGATE PA-C” Practice Location

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