Healthcare Provider Details

I. General information

NPI: 1629476619
Provider Name (Legal Business Name): CHARIS WILLIAMS CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE SUITE LL2
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

8506 CEDAR CHASE DR
CLINTON MD
20735-1985
US

V. Phone/Fax

Practice location:
  • Phone: 202-450-5891
  • Fax: 202-610-2699
Mailing address:
  • Phone: 402-202-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1504580
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number23431
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: