Healthcare Provider Details

I. General information

NPI: 1316040264
Provider Name (Legal Business Name): FELICIA DELORIS WASHINGTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/23/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 OLD CORNELIA HIGHWAY
GAINSVILLE GA
30507
US

IV. Provider business mailing address

536 WINDER TRL
CANTON GA
30114-7531
US

V. Phone/Fax

Practice location:
  • Phone: 779-533-7230
  • Fax:
Mailing address:
  • Phone: 662-435-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR740067
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN259622
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: