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General NPI Number Information
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NPI Number | 1639641673
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Entity Type | Organization
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Legal Business Name | JAMES A. ALTICK ,JR. M.D. A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 2804 KILPATRICK BLVD
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City | MONROE
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State | LA
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Zip | 71201-5139
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Country | US
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Telephone | 318-387-2545
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Fax | 318-387-2775
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Provider Business Mailing Address
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Address Line | 2804 KILPATRICK BLVD
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City | MONROE
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State | LA
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Zip | 71201-5139
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Country | US
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Telephone | 318-387-2545
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Fax | 318-387-2775
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBBIE NICHOLS
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Credential |
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Telephone | 318-387-2545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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