Provider Demographics
NPI:1821782814
Name:WASHINGTON, EDWARD ALLEN
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALLEN
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4762 CHUTNEY DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1638
Mailing Address - Country:US
Mailing Address - Phone:865-919-5740
Mailing Address - Fax:
Practice Address - Street 1:4762 CHUTNEY DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1638
Practice Address - Country:US
Practice Address - Phone:931-919-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker