Healthcare Provider Details

I. General information

NPI: 1083064927
Provider Name (Legal Business Name): WILLIE HARRINGTON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ALABAMA AVE SE
WASHINGTON DC
20032-4540
US

IV. Provider business mailing address

10412 JULEP AVE
SILVER SPRING MD
20902-3840
US

V. Phone/Fax

Practice location:
  • Phone: 202-299-5000
  • Fax:
Mailing address:
  • Phone: 678-371-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMTL003505
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: