Provider Demographics
NPI:1982635710
Name:REBAGAY, WINONA R (MD)
Entity Type:Individual
Prefix:DR
First Name:WINONA
Middle Name:R
Last Name:REBAGAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1514 ANTHONY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4817
Mailing Address - Country:US
Mailing Address - Phone:706-733-3406
Mailing Address - Fax:706-738-8757
Practice Address - Street 1:1514 ANTHONY RD
Practice Address - Street 2:SUITE D
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4817
Practice Address - Country:US
Practice Address - Phone:706-733-3406
Practice Address - Fax:706-738-8757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00810675AMedicaid
SCG46219OtherSCMEDICAID
SCG46219OtherSCMEDICAID
GAG79251Medicare UPIN