Provider Demographics
NPI:1245959964
Name:WILLIAMS, ERVIN RILEY
Entity type:Individual
Prefix:
First Name:ERVIN
Middle Name:RILEY
Last Name: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 1:1701 GOULD DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1781
Mailing Address - Country:US
Mailing Address - Phone:202-360-0859
Mailing Address - Fax:
Practice Address - Street 1:896 SOUTHERN AVE SE APT 310
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3451
Practice Address - Country:US
Practice Address - Phone:202-309-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant