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General NPI Number Information
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NPI Number | 1366775892
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Entity Type | Individual
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Provider Name | MS. JACQUELINE YVETTE WASHINGTON
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Gender | Female
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 116 LAUGHLIN DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-6015
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Country | US
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Telephone | 770-833-2851
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Fax | 770-957-0522
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Provider Business Mailing Address
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Address Line | 116 LAUGHLIN DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-6015
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Country | US
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Telephone | 770-833-2851
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Fax | 888-493-4555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | GA
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