Provider Demographics
NPI:1649586330
Name:WHICKER, WINFRY EVANS (MD)
Entity Type:Individual
Prefix:DR
First Name:WINFRY
Middle Name:EVANS
Last Name:WHICKER
Suffix:
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 1:3700 TAYLOR GLEN LN NW
Mailing Address - Street 2:#355
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3400
Mailing Address - Country:US
Mailing Address - Phone:704-652-7464
Mailing Address - Fax:
Practice Address - Street 1:3700 TAYLOR GLEN LN NW
Practice Address - Street 2:#355
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3400
Practice Address - Country:US
Practice Address - Phone:704-652-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13948261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2939OtherGENERAL MEDICAL