Provider Demographics
NPI:1386821890
Name:KEVIN WASHINGTON
Entity Type:Organization
Organization Name:KEVIN WASHINGTON
Other - Org Name:STEADYHANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:3134
Authorized Official - Phone:678-691-3187
Mailing Address - Street 1:411 PARKWAY CIR S
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-6305
Mailing Address - Country:US
Mailing Address - Phone:678-691-3187
Mailing Address - Fax:
Practice Address - Street 1:411 PARKWAY CIRCLE SOUTH
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-6305
Practice Address - Country:US
Practice Address - Phone:678-691-3187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3134261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical