Healthcare Provider Details

I. General information

NPI: 1134042203
Provider Name (Legal Business Name): GARRETT EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 BENNING RD NE
WASHINGTON DC
20019-4555
US

IV. Provider business mailing address

420 N COLLINGTON AVE
BALTIMORE MD
21231-1308
US

V. Phone/Fax

Practice location:
  • Phone: 202-469-4699
  • Fax: 202-548-8680
Mailing address:
  • Phone: 510-730-9463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200008968
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: