Provider Demographics
NPI:1255115986
Name:HAYWOOD, JABIARI BRYAN
Entity type:Individual
Prefix:MR
First Name:JABIARI
Middle Name:BRYAN
Last Name:HAYWOOD
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 1:1765 ONEAL LN # 321
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1633
Mailing Address - Country:US
Mailing Address - Phone:504-388-1680
Mailing Address - Fax:
Practice Address - Street 1:1765 ONEAL LN # 321
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1633
Practice Address - Country:US
Practice Address - Phone:504-388-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008814207343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)