Provider Demographics
NPI:1457977902
Name:WASHINGTON, ANGELA BUSSEY (ANGELA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BUSSEY
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:ANGELA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-9357
Mailing Address - Country:US
Mailing Address - Phone:803-270-8635
Mailing Address - Fax:
Practice Address - Street 1:109 W BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3832
Practice Address - Country:US
Practice Address - Phone:803-270-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist