Provider Demographics
NPI:1275299349
Name:COLEY, JOHN EDWARD JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:COLEY
Suffix:JR
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 1:151 Q ST NE APT 3421
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2290
Mailing Address - Country:US
Mailing Address - Phone:202-327-4985
Mailing Address - Fax:
Practice Address - Street 1:151 Q ST NE APT 3421
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2290
Practice Address - Country:US
Practice Address - Phone:202-327-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant