Provider Demographics
NPI:1548643307
Name:WASHINGTON, GARY NATHAN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:NATHAN
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ROCK SPRINGS PL NE APT 113
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2383
Mailing Address - Country:US
Mailing Address - Phone:678-446-1308
Mailing Address - Fax:
Practice Address - Street 1:12 7TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-3202
Practice Address - Country:US
Practice Address - Phone:770-848-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204167363LF0000X
MDR215808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily