Individual provider Active NPI

Dominique Jenetta Williams

  • Student in an Organized Health Care Education/Training Program
  • Fort Washington, MD
National Provider Identifier
1881579712
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
8507 Oxon Hill Rd Ste 200
Fort Washington, MD 20744-4774
Phone
(575) 904-0959
NPI assigned
Aug 8, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

8507 Oxon Hill Rd Ste 200
Fort Washington, MD 20744-4774

Mailing address

4658 Presidential Pkwy
Macon, GA 31206-8708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1881579712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4658 PRESIDENTIAL PKWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312068708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8507 OXON HILL RD STE 200",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207444774",
            "telephone_number": "575-904-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DOMINIQUE",
        "middle_name": "JENETTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-08",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Washington, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.