Healthcare Provider Details

I. General information

NPI: 1396018958
Provider Name (Legal Business Name): JONES DZEWO BONGHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 GEORGIA AVE NW SUITE 323
WASHINGTON DC
20012-1616
US

IV. Provider business mailing address

7600 GEORGIA AVE NW SUITE 323
WASHINGTON DC
20012-1616
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-3060
  • Fax: 202-723-3065
Mailing address:
  • Phone: 202-723-3060
  • Fax: 202-723-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN1007237
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: