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:
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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 1:2061 EXPERIMENT STATION RD STE 505
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5327
Practice Address - Country:US
Practice Address - Phone:706-310-0324
Practice Address - Fax:800-305-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN40364207P00000X
GA032498207Q00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE75674Medicare UPIN