Provider Demographics
NPI:1912296468
Name:WASHINGTON, RICHARD TERRY JR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TERRY
Last Name:WASHINGTON
Suffix:JR
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 1:5108 SINGING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5694
Mailing Address - Country:US
Mailing Address - Phone:615-971-6507
Mailing Address - Fax:615-641-7588
Practice Address - Street 1:5108 SINGING HILLS DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5694
Practice Address - Country:US
Practice Address - Phone:615-971-6507
Practice Address - Fax:615-641-7588
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00184363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical