Provider Demographics
NPI:1134380520
Name:UGBAJAH, WINSTON C (MD)
Entity type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:C
Last Name:UGBAJAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BENJAMIN HL
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-9513
Mailing Address - Country:US
Mailing Address - Phone:229-424-7263
Mailing Address - Fax:
Practice Address - Street 1:116 BENJAMIN HILL DRIVE
Practice Address - Street 2:SUITE 12
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750
Practice Address - Country:US
Practice Address - Phone:229-424-7263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine