Healthcare Provider Details

I. General information

NPI: 1093624421
Provider Name (Legal Business Name): WILLIE WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GRANBY XING
CAYCE SC
29033-4300
US

IV. Provider business mailing address

201 GRANDBY CROSSING
CAYCE SC
29033
US

V. Phone/Fax

Practice location:
  • Phone: 404-884-4620
  • Fax:
Mailing address:
  • Phone: 404-884-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: