Provider Demographics
NPI:1437762457
Name:GREEN-WILLIAMS, CHASE
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:GREEN-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 1:1962 ROCHELL AVE APT 826
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1463
Mailing Address - Country:US
Mailing Address - Phone:202-677-1154
Mailing Address - Fax:
Practice Address - Street 1:1100 MISSISSIPPI AVE SE APT 344
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4450
Practice Address - Country:US
Practice Address - Phone:202-424-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant