Provider Demographics
NPI:1649547837
Name:WASHINGTON, JUDITH (MED)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 MACON RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-9293
Mailing Address - Country:US
Mailing Address - Phone:706-615-7011
Mailing Address - Fax:
Practice Address - Street 1:6751 MACON RD
Practice Address - Street 2:SUITE 6
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-9293
Practice Address - Country:US
Practice Address - Phone:706-615-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA220039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist