Healthcare Provider Details

I. General information

NPI: 1548643307
Provider Name (Legal Business Name): GARY NATHAN WASHINGTON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 7TH ST
AUBURN GA
30011-3202
US

IV. Provider business mailing address

550 ROCK SPRINGS PL NE APT 113
ATLANTA GA
30306-2383
US

V. Phone/Fax

Practice location:
  • Phone: 770-848-9320
  • Fax:
Mailing address:
  • Phone: 678-446-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN204167
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR215808
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: