Provider Demographics
NPI:1770504631
Name:BUTLIN, WINFIELD E (DPM)
Entity Type:Individual
Prefix:
First Name:WINFIELD
Middle Name:E
Last Name:BUTLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 WINTERS CHAPEL RD
Mailing Address - Street 2:STE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2705
Mailing Address - Country:US
Mailing Address - Phone:770-285-7246
Mailing Address - Fax:
Practice Address - Street 1:2193 NORTHLAKE PKWY
Practice Address - Street 2:STE 114
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4116
Practice Address - Country:US
Practice Address - Phone:770-938-5974
Practice Address - Fax:770-939-7393
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA322213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00006311BMedicaid
GA316899OtherUNITED HEALTHCARE
480021837OtherMCR RAILROAD
517896OtherAETNA
GA121113OtherBLUE CROSS BLUE SHIELD
GA316899OtherUNITED HEALTHCARE
GAT97520Medicare UPIN
GAP00370542Medicare PIN
480021837OtherMCR RAILROAD