Healthcare Provider Details

I. General information

NPI: 1316868433
Provider Name (Legal Business Name): DE'MOND MARCELL JOHNSON I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 FLORIDA AVE NW APT 954
WASHINGTON DC
20001-5597
US

IV. Provider business mailing address

71 POTOMAC AVE SE APT 306
WASHINGTON DC
20003-4952
US

V. Phone/Fax

Practice location:
  • Phone: 202-766-3043
  • Fax:
Mailing address:
  • Phone: 202-853-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: