Provider Demographics
NPI:1215788997
Name:GOODMAN, AJIA
Entity type:Individual
Prefix:
First Name:AJIA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 QUINCY ST NW APT 604
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5869
Mailing Address - Country:US
Mailing Address - Phone:202-940-2974
Mailing Address - Fax:
Practice Address - Street 1:850 QUINCY ST NW APT 604
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5869
Practice Address - Country:US
Practice Address - Phone:202-940-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator