Provider Demographics
NPI:1710900162
Name:JESHURAN, WINSTON R (MD)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:R
Last Name:JESHURAN
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 1:310 HOSPITAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8026
Mailing Address - Country:US
Mailing Address - Phone:478-787-6255
Mailing Address - Fax:478-812-8700
Practice Address - Street 1:310 HOSPITAL DR STE 210
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8026
Practice Address - Country:US
Practice Address - Phone:478-787-6255
Practice Address - Fax:478-812-8700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59432207XS0117X
MDD64605207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA560184785BMedicaid
GAP00763724OtherMEDICARE RAILROAD
GAP00763724OtherMEDICARE RAILROAD