Provider Demographics
NPI:1013918515
Name:WINSTEAD, TIMOTHY EUGENE (AUD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:WINSTEAD
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BULLSBORO DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1570
Mailing Address - Country:US
Mailing Address - Phone:770-251-2927
Mailing Address - Fax:770-251-2995
Practice Address - Street 1:181 UPPER RIVERDALE RD SW
Practice Address - Street 2:STE 1A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4919
Practice Address - Country:US
Practice Address - Phone:770-996-2861
Practice Address - Fax:770-991-1604
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1010231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64BCBHHMedicare ID - Type Unspecified
GAR80110Medicare UPIN