Provider Demographics
NPI:1326787359
Name:WINN, CALEB MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:MICHAEL
Last Name:WINN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25381 EVANFORD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-1304
Mailing Address - Country:US
Mailing Address - Phone:207-590-2862
Mailing Address - Fax:
Practice Address - Street 1:4100 GOSS RD SW
Practice Address - Street 2:
Practice Address - City:REDSTONE ARSENAL
Practice Address - State:AL
Practice Address - Zip Code:35809-0001
Practice Address - Country:US
Practice Address - Phone:256-955-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE2940208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program