Provider Demographics
NPI:1225026479
Name:WASHINGTON, MARCUS A SR (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:A
Last Name:WASHINGTON
Suffix:SR
Gender:M
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:PO BOX 277723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7723
Mailing Address - Country:US
Mailing Address - Phone:864-560-6000
Mailing Address - Fax:
Practice Address - Street 1:7450 S MASON MONTGOMERY RD UNIT 200
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8080
Practice Address - Country:US
Practice Address - Phone:513-204-5785
Practice Address - Fax:513-229-0228
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-096641207Q00000X
NC200501084207Q00000X
SC84824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902280Medicaid
OH3145028Medicaid
SC848248Medicaid
NC5902280Medicaid