Provider Demographics
NPI:1891780052
Name:WASHINGTON, TONYA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:TONYA
Middle Name:RENEE
Last Name:WASHINGTON
Suffix:
Gender:F
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:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:322 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379
Practice Address - Country:US
Practice Address - Phone:864-429-8029
Practice Address - Fax:864-429-3515
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-T6531207Q00000X
SC22412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT65319Medicaid
SCSC4964H888OtherMEDICARE PIN
SCH324048887Medicare PIN
SC5050Medicare PIN
SCH32404Medicare UPIN
SC9159Medicare PIN
SC8887Medicare PIN