Provider Demographics
NPI:1407007552
Name:WASHINGTON, JOHNNY JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:WASHINGTON
Suffix:JR
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 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-383-1010
Mailing Address - Fax:904-244-3457
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1010
Practice Address - Fax:904-244-3457
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64298207XX0005X
FLME133343207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003150119LMedicaid
GA003150119DMedicaid
GA003150119IMedicaid
GA02427208OtherAMERIGROUP
GA003150119CMedicaid
GA003150119GMedicaid
GA003150119JMedicaid
1023416OtherWELLCARE
GA003150119EMedicaid
GA003150119HMedicaid
GA003150119KMedicaid
GA0532272OtherCIGNA
GA003150119FMedicaid
GA202I208229OtherMEDICARE
GA003150119AMedicaid
GA003150119BMedicaid