Provider Demographics
NPI:1114909124
Name:WASHINGTON, MITZI ANN (MD)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:ANN
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 1:400 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7801
Mailing Address - Country:US
Mailing Address - Phone:501-279-9000
Mailing Address - Fax:501-279-9011
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6848
Practice Address - Country:US
Practice Address - Phone:501-279-0502
Practice Address - Fax:501-279-0506
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7762207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR420066OtherUNITED HEALTH CARE
AR53355OtherAR BLUE CROSS BLUE SHIELD
AR12098000000OtherQUALCHOICE
AR123525001Medicaid
AR53355OtherAR BLUE CROSS BLUE SHIELD
AR123525001Medicaid