Healthcare Provider Details

I. General information

NPI: 1407817638
Provider Name (Legal Business Name): E TAYLOR AULTMAN JR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 DANTE ST
NEW ORLEANS LA
70118-1014
US

IV. Provider business mailing address

744 DANTE ST
NEW ORLEANS LA
70118-1014
US

V. Phone/Fax

Practice location:
  • Phone: 504-866-3003
  • Fax: 504-866-8336
Mailing address:
  • Phone: 504-866-3003
  • Fax: 504-866-8336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number953LCSW
License Number StateLA

VIII. Authorized Official

Name: MR. EVERETT TAYLOR AULTMAN JR.
Title or Position: PRESIDENT OWNER
Credential: LCSW
Phone: 504-866-3003