Provider Demographics
NPI:1043783137
Name:GUIDRY, ALTON JERMAINE
Entity Type:Individual
Prefix:
First Name:ALTON
Middle Name:JERMAINE
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HARVEST SUGAR ROW
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-6183
Mailing Address - Country:US
Mailing Address - Phone:337-693-0159
Mailing Address - Fax:
Practice Address - Street 1:805 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6029
Practice Address - Country:US
Practice Address - Phone:337-678-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator