Basic Information
| Provider Information | |||||||||
| NPI: | 1376513713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHINGTON | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | WILLIARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314012917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125271000 | ||||||||
| FaxNumber: | 9125271126 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314012917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125271000 | ||||||||
| FaxNumber: | 9125271126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
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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 | 207R00000X | 066550 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 193757 | 05 | SC | MEDICAID |