Provider Demographics
NPI:1043558893
Name:WASHINGTON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 MORRIS ST NW
Mailing Address - Street 2:#2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4542
Mailing Address - Country:US
Mailing Address - Phone:770-896-8740
Mailing Address - Fax:
Practice Address - Street 1:2685 MORRIS ST NW
Practice Address - Street 2:#2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4542
Practice Address - Country:US
Practice Address - Phone:770-896-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172V0000X172V00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172V00000XOther Service ProvidersCommunity Health Worker