Provider Demographics
NPI:1255194122
Name:CHARLES, JAMIAN
Entity type:Individual
Prefix:
First Name:JAMIAN
Middle Name:
Last Name:CHARLES
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 1:4600 SHERWOOD COMMON BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4890
Mailing Address - Country:US
Mailing Address - Phone:225-253-7720
Mailing Address - Fax:
Practice Address - Street 1:4600 SHERWOOD COMMON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4890
Practice Address - Country:US
Practice Address - Phone:225-253-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist