1669669743 NPI number — DR. WINSTON PRICE M.D.

Table of content: DR. WINSTON PRICE M.D. (NPI 1669669743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669669743 NPI number — DR. WINSTON PRICE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
WINSTON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669669743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2518
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30023-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-220-5674
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E SHOTWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39819-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-220-5674
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  124177 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 058915 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00302089 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0513898008 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 423317390C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55475 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010124177NY01 . This is a "ANTHEM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20269 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".