Provider Demographics
NPI:1265925820
Name:WASHINGTON, BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2068
Mailing Address - Country:US
Mailing Address - Phone:770-793-7899
Mailing Address - Fax:770-793-7856
Practice Address - Street 1:2518 JIMMY LEE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2068
Practice Address - Country:US
Practice Address - Phone:770-793-7899
Practice Address - Fax:770-793-7856
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92395207Q00000X
SC52591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine