Provider Demographics
NPI:1205830577
Name:WASHINGTON, ANDREA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-1506
Mailing Address - Country:US
Mailing Address - Phone:678-625-3937
Mailing Address - Fax:770-786-8216
Practice Address - Street 1:4106 MILL ST NE STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2539
Practice Address - Country:US
Practice Address - Phone:678-625-3937
Practice Address - Fax:770-786-8216
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6630TG152W00000X
LA1420-541T152W00000X
GA2341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist