Healthcare Provider Details

I. General information

NPI: 1972367589
Provider Name (Legal Business Name): WELLPATRIOT VETERANS MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MIAMI CIR NE
ATLANTA GA
30324-3015
US

IV. Provider business mailing address

5112 CRESCENT COVE LN
MABLETON GA
30126-7622
US

V. Phone/Fax

Practice location:
  • Phone: 404-936-6216
  • Fax:
Mailing address:
  • Phone: 770-378-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN WASHINGTON SR.
Title or Position: OWNER/CHIEF MEDICAL OFFICER
Credential: MD
Phone: 770-378-0942