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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
7603 GEORGIA AVE NW, WASHINGTON, DC 20012-1617
(866) 327-6976
Mailing address
7603 GEORGIA AVE NW, WASHINGTON, DC 20012-1617

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
DC
172V00000X
Community Health Worker
Primary

Other

Enumeration date
06/03/2025
Last updated
06/08/2025
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