Individual
W WINSTON WILFONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4 LIVE OAK CT, MOULTRIE, GA 31768-6783
(229) 785-2400
(229) 207-2532
Mailing address
PO BOX 1539, MOULTRIE, GA 31776-1539
(229) 785-2400
(229) 207-2532
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
028479
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000391036B
—
GA
01
—
102I342359
MEDICARE PTAN
GA
01
—
202G701316
MEDICARE GROUP PTAN
GA
Enumeration date
02/26/2007
Last updated
11/08/2016
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