Individual
WINSTON CLARK BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 723-4428
Mailing address
1022 BRISTOL TRL, EVANS, GA 30809-8259
(210) 381-5250
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2007002508
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
916364409
—
MO
Enumeration date
03/26/2008
Last updated
04/13/2013
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