Healthcare Provider Details

I. General information

NPI: 1477265833
Provider Name (Legal Business Name): GEORGE LOSHA AWUNE LOSHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12806 STONECREST DR
SILVER SPRING MD
20904-5235
US

IV. Provider business mailing address

12806 STONECREST DR
SILVER SPRING MD
20904-5235
US

V. Phone/Fax

Practice location:
  • Phone: 240-821-0726
  • Fax:
Mailing address:
  • Phone: 240-821-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: