Provider Demographics
NPI:1770380321
Name:MAYES, DERRICK II
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:MAYES
Suffix:II
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DERRICK
Other - Middle Name:
Other - Last Name:MAYES
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1629 K ST NW STE 1100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1640
Mailing Address - Country:US
Mailing Address - Phone:202-745-0073
Mailing Address - Fax:
Practice Address - Street 1:1629 K ST NW STE 1100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1640
Practice Address - Country:US
Practice Address - Phone:202-745-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator