Individual
MARY E WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1061 HARMON AVE, SUITE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6633
Mailing address
1061 HARMON AVE, SUITE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6633
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35.061059
OH
207Q00000X
Family Medicine Physician
Primary
36.12214
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0837670
—
OH
Enumeration date
03/14/2006
Last updated
11/29/2011
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