Provider Demographics
NPI:1023714938
Name:WILLIAMS, REGINALD SR
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 EFFIE FOX WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:240-460-1830
Mailing Address - Fax:
Practice Address - Street 1:201 I STREET SW
Practice Address - Street 2:#501
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024
Practice Address - Country:US
Practice Address - Phone:202-609-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide