Provider Demographics
NPI:1023690435
Name:WILLIAMS, TAFAURIA J (RDN)
Entity type:Individual
Prefix:MS
First Name:TAFAURIA
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 MARKET ST NE # 317
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3851
Mailing Address - Country:US
Mailing Address - Phone:202-486-1625
Mailing Address - Fax:
Practice Address - Street 1:2490 MARKET ST NE # 317
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3851
Practice Address - Country:US
Practice Address - Phone:202-486-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC863007333Medicaid