Provider Demographics
NPI:1780563650
Name:WASHINGTON, CLEATONIA A
Entity type:Individual
Prefix:
First Name:CLEATONIA
Middle Name:A
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 1:443 SUTHERLAND RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:MS
Mailing Address - Zip Code:39045-9610
Mailing Address - Country:US
Mailing Address - Phone:601-253-4985
Mailing Address - Fax:
Practice Address - Street 1:443 SUTHERLAND RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:MS
Practice Address - Zip Code:39045-9610
Practice Address - Country:US
Practice Address - Phone:601-253-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver