Healthcare Provider Details

I. General information

NPI: 1164232690
Provider Name (Legal Business Name): ANTONIO WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TOWNE PARK DR
RINCON GA
31326-9368
US

IV. Provider business mailing address

1808 NORTHGATE DR
SAVANNAH GA
31404-4301
US

V. Phone/Fax

Practice location:
  • Phone: 854-204-0440
  • Fax:
Mailing address:
  • Phone: 912-631-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: