Individual
MS. SHONTA K WINBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
704 GIL HARBIN IND BLVD, VALDOSTA, GA 31602
(229) 242-9003
(229) 242-0490
Mailing address
PO BOX 148, QUITMAN, GA 31643
(229) 263-8956
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3776
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
244832811A
—
GA
Enumeration date
09/26/2006
Last updated
07/08/2007
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