Provider Demographics
NPI:1972554699
Name:WINGATE, HARRY LYNNWOOD III (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:LYNNWOOD
Last Name:WINGATE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1469 GEORGIA CLUB DR
Mailing Address - Street 2:
Mailing Address - City:STATHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30666-2542
Mailing Address - Country:US
Mailing Address - Phone:706-340-1077
Mailing Address - Fax:
Practice Address - Street 1:1469 GEORGIA CLUB DR
Practice Address - Street 2:
Practice Address - City:STATHAM
Practice Address - State:GA
Practice Address - Zip Code:30666-2542
Practice Address - Country:US
Practice Address - Phone:706-340-1077
Practice Address - Fax:800-305-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032498207PE0004X, 207Q00000X
TN40364207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE75674Medicare UPIN