Provider Demographics
NPI:1902829039
Name:WINN, MICHAEL JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:WINN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5511 RAEFORD RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2057
Mailing Address - Country:US
Mailing Address - Phone:910-630-5000
Mailing Address - Fax:910-424-6767
Practice Address - Street 1:5511 RAEFORD ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2058
Practice Address - Country:US
Practice Address - Phone:910-630-5000
Practice Address - Fax:910-424-6767
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00472363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-00472OtherNC LICENSE