Provider Demographics
NPI:1750035812
Name:HARKLESS, ALBERT III
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:HARKLESS
Suffix:III
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 1:5805 CLOVERLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1312
Mailing Address - Country:US
Mailing Address - Phone:301-332-4875
Mailing Address - Fax:
Practice Address - Street 1:530 46TH ST SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7812
Practice Address - Country:US
Practice Address - Phone:301-332-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide