Provider Demographics
NPI:1265836159
Name:AGBAJE, WILLIAMS
Entity Type:Individual
Prefix:
First Name:WILLIAMS
Middle Name:
Last Name:AGBAJE
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 1:7767 RIVERDALE RD APT 302
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3929
Mailing Address - Country:US
Mailing Address - Phone:240-413-2908
Mailing Address - Fax:
Practice Address - Street 1:7767 RIVERDALE RD APT 302
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3929
Practice Address - Country:US
Practice Address - Phone:240-413-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10967374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide