Basic Information
| Provider Information | |||||||||
| NPI: | 1255335022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHBURN | ||||||||
| FirstName: | HARRILL | ||||||||
| MiddleName: | GENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 144 RESERVATION DR | ||||||||
| Address2: | |||||||||
| City: | SPINDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281601566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282870200 | ||||||||
| FaxNumber: | 8282878755 | ||||||||
| Practice Location | |||||||||
| Address1: | 144 RESERVATION DR | ||||||||
| Address2: | |||||||||
| City: | SPINDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281601566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282870200 | ||||||||
| FaxNumber: | 8282878755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 06/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9700800 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2238032 | 01 | NC | MEDICARE PTAN | OTHER | BW4668274 | 01 | NC | DEA | OTHER | 8910836 | 05 | NC | MEDICAID |