Healthcare Provider Details

I. General information

NPI: 1174885263
Provider Name (Legal Business Name): MARTHA EBAI ATABONGAKENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 360
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

11703 HOLLY HOCK CT
UPPER MARLBORO MD
20774-9302
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-8494
  • Fax:
Mailing address:
  • Phone: 301-326-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004397
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: