Organization
USCG HEADQUARTERS SUPPORT COMMAND (K)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILLYNDA A. WILLIAMS (CLINIC SUPERVISOR)
(202) 372-4103
Entity
Organization
Contact information
Practice address
COMDT 2100 2ND ST SW, CG-1122, SUITE 5314, WASHINGTON, DC 20593-0001
(202) 372-4103
(202) 372-4912
Mailing address
COMDT 2100 2ND ST SW, CG-1122, SUITE 5314, WASHINGTON, DC 20593-0001
(202) 372-4103
(202) 372-4912
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Enumeration date
10/31/2006
Last updated
08/22/2020
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