Provider Demographics
NPI:1649460999
Name:WASHINGTON, CHAD WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WAYNE
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 1:2500 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5706
Mailing Address - Fax:601-984-5733
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5706
Practice Address - Fax:601-984-5733
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012006604207T00000X
MS23739207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS184168Medicaid
MS04954267Medicaid
MSP01653140OtherRAILROAD MEDICARE PTAN
MSP01653140OtherRAILROAD MEDICARE PTAN