Provider Demographics
NPI:1801010061
Name:WASHINGTON, LATONYA (MD)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:WASHINGTON
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 1:200 S RHODES ST STE C
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4213
Mailing Address - Country:US
Mailing Address - Phone:870-394-4387
Mailing Address - Fax:870-394-9751
Practice Address - Street 1:200 S RHODES ST STE C
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4213
Practice Address - Country:US
Practice Address - Phone:870-394-4387
Practice Address - Fax:870-394-9751
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243844207R00000X, 208000000X
TN48375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00685257OtherRR MEDICARE
VA018348V16Medicare PIN