Provider Demographics
NPI:1689935116
Name:WILLIAMS, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4342 LIVINGSTON RD SE
Mailing Address - Street 2:SE APT. # B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2930
Mailing Address - Country:US
Mailing Address - Phone:202-460-7943
Mailing Address - Fax:
Practice Address - Street 1:4342 LIVINGSTON RD SE
Practice Address - Street 2:SE APT. # B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2930
Practice Address - Country:US
Practice Address - Phone:202-460-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide