Provider Demographics
NPI:1598306557
Name:FITZGERALD, PRECIOUS CHARMAINE
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:CHARMAINE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LOWER WOODVILLE RD APT F144
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4460
Mailing Address - Country:US
Mailing Address - Phone:601-317-9206
Mailing Address - Fax:
Practice Address - Street 1:824 ELMWOOD PARK BLVD STE 150
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3347
Practice Address - Country:US
Practice Address - Phone:318-414-3065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator