Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN204600 | GA |
NPI | 1033783998 |
---|---|
Provider Name | Lance Timothy Washington |
First Address | Decatur, GA 30033-2650 |
Second Address | Decatur, GA 30033-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2021 |
Last Update Date | 16/05/2021 |