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General NPI Number Information
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NPI Number | 1538122478
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Entity Type | Individual
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Provider Name | SIDNEY R WASHINGTON III MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 1878 BRANNEN LAKE RD
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City | STATESBORO
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State | GA
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Zip | 30458-7257
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Country | US
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Telephone | 912-690-2724
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Fax | 912-852-2041
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Provider Business Mailing Address
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Address Line | 1878 BRANNEN LAKE RD
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City | STATESBORO
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State | GA
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Zip | 30458-7257
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Country | US
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Telephone | 912-690-2724
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Fax | 912-852-2041
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 028667
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 28667
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License Number State | GA
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