Provider Demographics
NPI:1417936386
Name:WASHINGTON, RENICE ANDREA (MSN)
Entity Type:Individual
Prefix:MS
First Name:RENICE
Middle Name:ANDREA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY RD
Mailing Address - Street 2:STE 130
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1631
Mailing Address - Country:US
Mailing Address - Phone:404-300-2990
Mailing Address - Fax:404-300-2986
Practice Address - Street 1:980 JOHNSON FERRY RD STE 910
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-303-3750
Practice Address - Fax:404-252-4755
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000937032CMedicaid
GA000937032CMedicaid
GAP52254Medicare UPIN