Provider Demographics
NPI:1033783998
Name:WASHINGTON, LANCE TIMOTHY
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:TIMOTHY
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 1:3131 N DRUID HILLS RD APT 7206
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2650
Mailing Address - Country:US
Mailing Address - Phone:404-516-4715
Mailing Address - Fax:
Practice Address - Street 1:3131 N DRUID HILLS RD APT 7206
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2650
Practice Address - Country:US
Practice Address - Phone:404-516-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health