Provider Demographics
NPI:1356002414
Name:CHILES, GREGORY K
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:CHILES
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 1:3712 MACARTHUR BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6802
Mailing Address - Country:US
Mailing Address - Phone:504-452-0881
Mailing Address - Fax:
Practice Address - Street 1:3712 MACARTHUR BLVD STE 209
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6802
Practice Address - Country:US
Practice Address - Phone:504-452-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant