Provider Demographics
NPI:1891273546
Name:AMOS, CHARLOTTE
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:THOMAS
Other - Last Name:AMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:248 COLLIN RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-7302
Mailing Address - Country:US
Mailing Address - Phone:318-243-1536
Mailing Address - Fax:
Practice Address - Street 1:248 COLLIN RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251
Practice Address - Country:US
Practice Address - Phone:318-243-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-04
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator