Healthcare Provider Details

I. General information

NPI: 1902748544
Provider Name (Legal Business Name): JONATHAN GERARD WILLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0002
US

IV. Provider business mailing address

1616 MIRABEAU AVE
NEW ORLEANS LA
70122-2512
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-0006
  • Fax:
Mailing address:
  • Phone: 504-231-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: