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NPI Code Detail

MEDICARE: MR. GARY NATHAN WASHINGTON FNP-C

MEDICARE: MR. GARY NATHAN WASHINGTON FNP-C
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
1363LF0000XFamily Nurse PractitionerRN204167GA
2363LF0000XFamily Nurse PractitionerR215808MD

General Provider Information

NPI Number : 1548643307
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY NATHAN WASHINGTON FNP-C
Provider Business Mailing Address
First Line : 550 ROCK SPRINGS PL NE APT 113
Second Line :
City : ATLANTA
State : GA
Zip : 30306-2383
Country : US
Telephone Number : 678-446-1308
Fax Number :
Provider Business Practice Location Address
First Line : 12 7TH ST
Second Line :
City : AUBURN
State : GA
Zip : 30011-3202
Country : US
Telephone Number : 770-848-9320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2015
Last Update Date : 07/11/2016

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