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General NPI Number Information
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NPI Number | 1225547342
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Entity Type | Organization
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Legal Business Name | PRESTIGE WORLDWIDE, LLC
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5505 JOHN ESKEW DR
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3725
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Country | US
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Telephone | 318-704-6008
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Fax |
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Provider Business Mailing Address
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Address Line | 5505 JOHN ESKEW DR
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3725
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Country | US
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Telephone | 318-704-6008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER JEFFREY CHARLES RODGMAN
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Credential | MD
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Telephone | 318-704-6008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD.205436
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License Number State | LA
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