Healthcare Provider Details

I. General information

NPI: 1447201249
Provider Name (Legal Business Name): GAIL REGINA DILLARD-WASHINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GAIL DILLARD WASHINGTON MD

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 COLONIAL DR
COLUMBIA SC
29203-4260
US

IV. Provider business mailing address

PO BOX 9828
COLUMBIA SC
29290-0828
US

V. Phone/Fax

Practice location:
  • Phone: 803-888-1106
  • Fax: 803-602-0035
Mailing address:
  • Phone: 803-661-1004
  • Fax: 803-779-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13574
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: