Healthcare Provider Details

I. General information

NPI: 1114909124
Provider Name (Legal Business Name): MITZI A WASHINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAIN ST SUITE 200
SEARCY AR
72143-6848
US

IV. Provider business mailing address

400 S MAIN ST STE 100
SEARCY AR
72143-7801
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-0502
  • Fax: 501-279-0506
Mailing address:
  • Phone: 501-279-9000
  • Fax: 501-279-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC-7762
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC-7762
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: