Healthcare Provider Details

I. General information

NPI: 1720496680
Provider Name (Legal Business Name): MS. CARLA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10338 MONTRACHET DR
BATON ROUGE LA
70817-7480
US

IV. Provider business mailing address

10338 MONTRACHET DR
BATON ROUGE LA
70817-7480
US

V. Phone/Fax

Practice location:
  • Phone: 225-931-6806
  • Fax:
Mailing address:
  • Phone: 225-931-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: