Basic Information
| Provider Information | |||||||||
| NPI: | 1578566360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINEGAR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BRYSTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376620009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238572066 | ||||||||
| FaxNumber: | 4238572070 | ||||||||
| Practice Location | |||||||||
| Address1: | 153 ROSS CARTER BLVD | ||||||||
| Address2: | |||||||||
| City: | DUFFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2764312648 | ||||||||
| FaxNumber: | 2764312082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 09/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD 13274 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101031442 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5641594 | 05 | VA | MEDICAID | 005641594 | 05 | VA | MEDICAID | 3185817 | 05 | TN | MEDICAID | 64116692 | 05 | KY | MEDICAID |