Provider Demographics
NPI:1306413828
Name:WILLIAMS, PATRICK KHARA
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KHARA
Last Name:WILLIAMS
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 1:4100 MASSACHUSETTS AVE NW APT 307
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4762
Mailing Address - Country:US
Mailing Address - Phone:571-758-9900
Mailing Address - Fax:
Practice Address - Street 1:1822 KENDALL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1637
Practice Address - Country:US
Practice Address - Phone:202-424-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant