Healthcare Provider Details

I. General information

NPI: 1639641673
Provider Name (Legal Business Name): JAMES A. ALTICK ,JR. M.D. A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 KILPATRICK BLVD
MONROE LA
71201-5139
US

IV. Provider business mailing address

2804 KILPATRICK BLVD
MONROE LA
71201-5139
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-2545
  • Fax: 318-387-2775
Mailing address:
  • Phone: 318-387-2545
  • Fax: 318-387-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE NICHOLS
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-387-2545