Healthcare Provider Details

I. General information

NPI: 1790444388
Provider Name (Legal Business Name): MR. JUWAN T WOMACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 VISTA ST NE
WASHINGTON DC
20018-4014
US

IV. Provider business mailing address

3214 VISTA ST NE
WASHINGTON DC
20018-4014
US

V. Phone/Fax

Practice location:
  • Phone: 202-424-4172
  • Fax:
Mailing address:
  • Phone: 202-424-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: