Provider Demographics
NPI:1730298845
Name:WILLIE CARNEGIE, GEORGIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:
Last Name:WILLIE CARNEGIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017
Mailing Address - Country:US
Mailing Address - Phone:202-832-1800
Mailing Address - Fax:202-832-2071
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-832-1800
Practice Address - Fax:202-832-2071
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD31765207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010201063Medicaid
DC033768400Medicaid
MD488503100Medicaid
DC033768400Medicaid
H56953Medicare UPIN
DCH56953Medicare UPIN