Healthcare Provider Details

I. General information

NPI: 1265470181
Provider Name (Legal Business Name): JAMAL KAVON GWATHNEY MD, MPH, FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-1548
US

IV. Provider business mailing address

14706 HARVEST LN
SILVER SPRING MD
20905-5641
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-1800
  • Fax: 202-279-4349
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD35077
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: