Healthcare Provider Details

I. General information

NPI: 1972440030
Provider Name (Legal Business Name): RONNIE WOODBERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MARION BARRY AVE SE APT 722
WASHINGTON DC
20020-5127
US

IV. Provider business mailing address

725 BRANDYWINE ST SE APT 303
WASHINGTON DC
20032-3560
US

V. Phone/Fax

Practice location:
  • Phone: 202-706-2068
  • Fax:
Mailing address:
  • Phone: 202-615-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: