Provider Demographics
NPI:1104661438
Name:WASHINGTON, CHARLES JAMES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JAMES
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 1:1090 BERKELEY ST APT 44
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-2935
Mailing Address - Country:US
Mailing Address - Phone:888-910-0573
Mailing Address - Fax:
Practice Address - Street 1:1090 BERKELEY ST APT 44
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-2935
Practice Address - Country:US
Practice Address - Phone:888-910-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC090476641172A00000X
2472E0500X, 374700000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG
No374700000XNursing Service Related ProvidersTechnician