Provider Demographics
NPI:1639890445
Name:WINNS, FREDRICK
Entity Type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:
Last Name:WINNS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2085
Mailing Address - Country:US
Mailing Address - Phone:843-340-7890
Mailing Address - Fax:
Practice Address - Street 1:572 DUNBAR RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2085
Practice Address - Country:US
Practice Address - Phone:843-359-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011511299172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver