1447201249 NPI number — DR. GAIL REGINA DILLARD-WASHINGTON MD

Table of content: DR. GAIL REGINA DILLARD-WASHINGTON MD (NPI 1447201249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447201249 NPI number — DR. GAIL REGINA DILLARD-WASHINGTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLARD-WASHINGTON
Provider First Name:
GAIL
Provider Middle Name:
REGINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WASHINGTON
Provider Other First Name:
GAIL
Provider Other Middle Name:
DILLARD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447201249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9828
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29290-0828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-661-1004
Provider Business Mailing Address Fax Number:
803-779-6623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4808 COLONIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-4260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-888-1106
Provider Business Practice Location Address Fax Number:
803-602-0035
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  13574 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 135749 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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