Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 032322 | GA |
NPI | 1255345419 |
---|---|
Provider Name | Dr. Carl V Washington |
First Address | Decatur, GA 30033-6149 |
Second Address | Decatur, GA 30033-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 15/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E50348 | (02) | GA |