# PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prince George's County Health Dept-Diabetes Prev Pgm
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366057523
- **Authorized official:** TAMALA VICKS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (301) 883-7822

## Contact information

- **Practice address:** 9314 PISCATAWAY RD, CLINTON, MD 20735-3630
- **Practice address phone:** (301) 883-7879
- **Mailing address:** 1701 MCCORMICK DR \# 120, LARGO, MD 20774-5329
- **Mailing address phone:** (301) 883-7822
- **Mailing address fax:** (301) 883-7890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174H00000X | Health Educator | — | NULL | Yes |
| 174H00000X | Health Educator | — | — | Yes |

## Other

- **Enumeration date:** 09/14/2020
- **Last updated:** 12/16/2025