Provider Demographics
NPI:1083627442
Name:WASHINGTON, JOHN H (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ARBOR CLIMB
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4237
Mailing Address - Country:US
Mailing Address - Phone:478-477-6583
Mailing Address - Fax:
Practice Address - Street 1:4 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1830
Practice Address - Country:US
Practice Address - Phone:706-283-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25398207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D42056Medicare UPIN