Provider Demographics
NPI:1639641673
Name:JAMES A. ALTICK ,JR. M.D. A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JAMES A. ALTICK ,JR. M.D. A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:JAMES A. ALTICK ,JR. M.D. PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-387-2545
Mailing Address - Street 1:2804 KILPATRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5139
Mailing Address - Country:US
Mailing Address - Phone:318-387-2545
Mailing Address - Fax:318-387-2775
Practice Address - Street 1:2804 KILPATRICK BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5139
Practice Address - Country:US
Practice Address - Phone:318-387-2545
Practice Address - Fax:318-387-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty