Provider Demographics
NPI:1073502324
Name:MAYO, TAMIKA SESSION (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMIKA
Middle Name:SESSION
Last Name:MAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 82109
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-2109
Mailing Address - Country:US
Mailing Address - Phone:225-381-2712
Mailing Address - Fax:225-381-2715
Practice Address - Street 1:3401 NORTH BLVD
Practice Address - Street 2:STE 360
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3743
Practice Address - Country:US
Practice Address - Phone:225-381-2712
Practice Address - Fax:225-381-2715
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA026311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576565Medicaid
LAI19579Medicare UPIN
LA1576565Medicaid