Provider Demographics
NPI:1447201249
Name:DILLARD-WASHINGTON, GAIL REGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:REGINA
Last Name:DILLARD-WASHINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:DILLARD
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9828
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29290-0828
Mailing Address - Country:US
Mailing Address - Phone:803-661-1004
Mailing Address - Fax:803-779-6623
Practice Address - Street 1:4808 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-4260
Practice Address - Country:US
Practice Address - Phone:803-888-1106
Practice Address - Fax:803-602-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13574208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC135749Medicaid
SC135749Medicaid