Provider Demographics
NPI:1033102629
Name:WINTERS, CHARLES JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WINTERS
Suffix:JR
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 1:1037 E OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4160
Mailing Address - Country:US
Mailing Address - Phone:615-860-0228
Mailing Address - Fax:615-865-2799
Practice Address - Street 1:1037 E OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4160
Practice Address - Country:US
Practice Address - Phone:615-860-0228
Practice Address - Fax:615-865-2799
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16862207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3018804Medicaid
TN3018804Medicaid
TNC46931Medicare UPIN