Provider Demographics
NPI:1245389642
Name:WINCHELL, MARK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:WINCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11909 MCAULEY DR
Mailing Address - Street 2:SUITE 100 A2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1793
Mailing Address - Country:US
Mailing Address - Phone:912-925-3767
Mailing Address - Fax:912-925-3659
Practice Address - Street 1:11909 MCAULEY DR
Practice Address - Street 2:SUITE 100 A2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1793
Practice Address - Country:US
Practice Address - Phone:912-925-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051568207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000948747BMedicaid
GAH58639OtherUPIN
GA20NCCJNMedicare PIN