Provider Demographics
NPI:1760280077
Name:WILLIAMS BLACKMON, GLENDA ANN
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:ANN
Last Name:WILLIAMS BLACKMON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 HAYES ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7016
Mailing Address - Country:US
Mailing Address - Phone:202-520-8819
Mailing Address - Fax:
Practice Address - Street 1:4303 MIDTOWN SQ APT 3034
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4430
Practice Address - Country:US
Practice Address - Phone:202-520-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant