Provider Demographics
NPI:1790720910
Name:WINFIELD OB/GYN
Entity Type:Organization
Organization Name:WINFIELD OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEMIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-487-1203
Mailing Address - Street 1:191 CARAWAY DR
Mailing Address - Street 2:SUITE A1
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5067
Mailing Address - Country:US
Mailing Address - Phone:205-487-1203
Mailing Address - Fax:205-487-1205
Practice Address - Street 1:191 CARAWAY DR
Practice Address - Street 2:SUITE A1
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5067
Practice Address - Country:US
Practice Address - Phone:205-487-1203
Practice Address - Fax:205-487-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51520459OtherBLUE CROSS
ALC74689Medicare UPIN