Provider Demographics
NPI:1053353938
Name:WINNIE, JOHN NORMAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NORMAN
Last Name:WINNIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 SECOND ST N STE B
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-9388
Mailing Address - Country:US
Mailing Address - Phone:912-496-4839
Mailing Address - Fax:
Practice Address - Street 1:4402 SECOND ST N STE B
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-9388
Practice Address - Country:US
Practice Address - Phone:912-496-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033757207Q00000X
FLME71017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000469785DMedicaid
GA000469785DMedicaid
GAE83820Medicare UPIN