Healthcare Provider Details

I. General information

NPI: 1932815065
Provider Name (Legal Business Name): ACHA ADANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-3622
US

IV. Provider business mailing address

6419 JODIE ST
NEW CARROLLTON MD
20784-3633
US

V. Phone/Fax

Practice location:
  • Phone: 202-733-4904
  • Fax:
Mailing address:
  • Phone: 912-230-7938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: