Provider Demographics
NPI:1164786950
Name:DJOMOU, TITA ANTHERME
Entity Type:Individual
Prefix:
First Name:TITA
Middle Name:ANTHERME
Last Name:DJOMOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 GEORGIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012
Mailing Address - Country:US
Mailing Address - Phone:202-723-3060
Mailing Address - Fax:202-723-3065
Practice Address - Street 1:2018 PALMER PARK RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4145
Practice Address - Country:US
Practice Address - Phone:301-605-2528
Practice Address - Fax:301-605-2528
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
DCHHA6372374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide