Healthcare Provider Details

I. General information

NPI: 1841050481
Provider Name (Legal Business Name): JACKSON MAX FRITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 PERDIDO ST
NEW ORLEANS LA
70112-1352
US

IV. Provider business mailing address

2021 PERDIDO ST
NEW ORLEANS LA
70112-1352
US

V. Phone/Fax

Practice location:
  • Phone: 504-412-1580
  • Fax:
Mailing address:
  • Phone: 504-412-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number341848
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: