Provider Demographics
NPI:1902414683
Name:WASHINGTON, VERNITA MONICA (LPN)
Entity Type:Individual
Prefix:
First Name:VERNITA
Middle Name:MONICA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1974 TALMADGE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31301-3201
Mailing Address - Country:US
Mailing Address - Phone:912-604-6933
Mailing Address - Fax:912-877-1111
Practice Address - Street 1:1974 TALMADGE RD
Practice Address - Street 2:
Practice Address - City:ALLENHURST
Practice Address - State:GA
Practice Address - Zip Code:31301-3201
Practice Address - Country:US
Practice Address - Phone:912-604-6933
Practice Address - Fax:912-877-1111
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN062821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004336Medicaid