MEDICARE: BETTY WASHINGTON MA, RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	250	SC

General Provider Information

NPI Number	:	1093134967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY WASHINGTON MA, RDN, LD

Provider Business Mailing Address
First Line	:	1070 S LAKE DR STE B
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-3701
Country	:	US
Telephone Number	:	803-785-6622
Fax Number	:	803-785-6555

Provider Business Practice Location Address
First Line	:	1070 S LAKE DR STE B
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-3701
Country	:	US
Telephone Number	:	803-785-6622
Fax Number	:	803-785-6555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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