Provider Demographics
NPI:1740410646
Name:ROSHELL, WINFRED C
Entity Type:Individual
Prefix:MR
First Name:WINFRED
Middle Name:C
Last Name:ROSHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:WIN
Other - Middle Name:C
Other - Last Name:ROSHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3638 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1853
Mailing Address - Country:US
Mailing Address - Phone:478-757-9909
Mailing Address - Fax:478-757-0195
Practice Address - Street 1:3638 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1853
Practice Address - Country:US
Practice Address - Phone:478-757-9909
Practice Address - Fax:478-757-0195
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies