Healthcare Provider Details

I. General information

NPI: 1730298845
Provider Name (Legal Business Name): GEORGIA WILLIE CARNEGIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE 100
WASHINGTON DC
20017
US

IV. Provider business mailing address

1160 VARNUM ST NE 100
WASHINGTON DC
20017
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-1800
  • Fax: 202-832-2071
Mailing address:
  • Phone: 202-832-1800
  • Fax: 202-832-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD31765
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: