Provider Demographics
NPI:1366677338
Name:WASHINGTON, KATRENNA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATRENNA
Middle Name:MARIE
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 1:285 CENTENNIAL OLYMPIC PARK DR NW UNIT 1704
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1851
Mailing Address - Country:US
Mailing Address - Phone:314-346-9549
Mailing Address - Fax:
Practice Address - Street 1:150 COBB PKWY S
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9209
Practice Address - Country:US
Practice Address - Phone:770-499-8332
Practice Address - Fax:770-499-1809
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist