Provider Demographics
NPI:1427575653
Name:ALSTON, GARY DAVOINE
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DAVOINE
Last Name:ALSTON
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 1:3630 BROTHERS PL SE APT T1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1575
Mailing Address - Country:US
Mailing Address - Phone:202-702-4766
Mailing Address - Fax:
Practice Address - Street 1:3630 BROTHERS PL SE APT T1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1575
Practice Address - Country:US
Practice Address - Phone:202-702-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant