Healthcare Provider Details

I. General information

NPI: 1700674033
Provider Name (Legal Business Name): MARSHA S WASHINGTON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SAINT MATTHEWS RD
ORANGEBURG SC
29118-1442
US

IV. Provider business mailing address

PO BOX 960
HOLLY HILL SC
29059-0960
US

V. Phone/Fax

Practice location:
  • Phone: 803-533-2200
  • Fax:
Mailing address:
  • Phone: 803-537-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30167
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: