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Individual

KAVON WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3807 ST. BARNABAS RD. #104, SUITLAND, MD 20746
(202) 394-4579
Mailing address
3807 ST. BARNABAS RD. #104, SUITLAND, MD 20746
(202) 394-4579

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
DC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4549360
DC
Enumeration date
06/09/2022
Last updated
06/09/2022
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