Basic Information
| Provider Information | |||||||||
| NPI: | 1659412039 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITALMD OF WINONA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CAMDEN COPE | ||||||||
| Address2: | P.O. BOX 2087 | ||||||||
| City: | PEACHTREE CITY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302692455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783641422 | ||||||||
| FaxNumber: | 6783641423 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 TYLER HOLMES DR | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 389671521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622834114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BURNETTE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | HAROLD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6783641422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.