Provider Demographics
NPI:1073793238
Name:WASHINGTON, KEVIN (CFA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFA
Mailing Address - Street 1:3200 STONE RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2900
Mailing Address - Country:US
Mailing Address - Phone:770-427-5114
Mailing Address - Fax:
Practice Address - Street 1:3200 GALLOWS ROAD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:678-451-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3134246ZC0007X
GACERT3134246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582625656OtherTAX ID