Healthcare Provider Details

I. General information

NPI: 1164800439
Provider Name (Legal Business Name): ARCHIE DAVIS III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 H ST NE
WASHINGTON DC
20002-3627
US

IV. Provider business mailing address

712 H ST NE
WASHINGTON DC
20002-3627
US

V. Phone/Fax

Practice location:
  • Phone: 240-559-4010
  • Fax:
Mailing address:
  • Phone: 240-559-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13982
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG50078801
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: