Provider Demographics
NPI:1316757883
Name:WASHINGTON, MALIK
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 6TH AVE APT F
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-1334
Mailing Address - Country:US
Mailing Address - Phone:910-207-1305
Mailing Address - Fax:
Practice Address - Street 1:75 RAILROAD ST E
Practice Address - Street 2:
Practice Address - City:CERRO GORDO
Practice Address - State:NC
Practice Address - Zip Code:28430
Practice Address - Country:US
Practice Address - Phone:910-654-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14853416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport