Healthcare Provider Details

I. General information

NPI: 1447182415
Provider Name (Legal Business Name): PRINCE GEORGE'S COUNTY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 MATTHEWS RD UNIT 105-107
BRYANS ROAD MD
20616-4265
US

IV. Provider business mailing address

9187 CENTRAL AVE
CAPITOL HEIGHTS MD
20743-3806
US

V. Phone/Fax

Practice location:
  • Phone: 301-883-7879
  • Fax:
Mailing address:
  • Phone: 301-883-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: TAMALA VICKS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 301-883-7822