Healthcare Provider Details

I. General information

NPI: 1831314905
Provider Name (Legal Business Name): JAMES ALFRED CHIVERTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 WABASH ST
METAIRIE LA
70001-1031
US

IV. Provider business mailing address

4933 WABASH ST
METAIRIE LA
70001-1031
US

V. Phone/Fax

Practice location:
  • Phone: 504-780-2766
  • Fax: 504-218-4607
Mailing address:
  • Phone: 504-780-2766
  • Fax: 504-218-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLA022226
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD.022226
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: