Provider Demographics
NPI:1497712418
Name:WINGATE, CHERYL BENITA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:BENITA
Last Name:WINGATE
Suffix:
Gender:F
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:PO BOX 1339
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1339
Mailing Address - Country:US
Mailing Address - Phone:478-453-0175
Mailing Address - Fax:
Practice Address - Street 1:1703 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1320
Practice Address - Country:US
Practice Address - Phone:304-366-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033257207V00000X
CO47602207V00000X
WV23838207V00000X
FL67579207V00000X
SC31535207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000658072IMedicaid
COCO304596Medicare PIN
GAG03245Medicare UPIN
GA000658072IMedicaid