Provider Demographics
NPI:1093739468
Name:WASHINGTON, EARNEST CHARLES (IDC)
Entity Type:Individual
Prefix:MR
First Name:EARNEST
Middle Name:CHARLES
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 CRAGGY PERCH
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8718
Mailing Address - Country:US
Mailing Address - Phone:843-228-3384
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL BEAUFORT
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-228-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient