Provider Demographics
NPI:1477080133
Name:CHARLES, RONNIE (BA)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7612 PICARDY AVE STE K
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4353
Mailing Address - Country:US
Mailing Address - Phone:225-331-0032
Mailing Address - Fax:
Practice Address - Street 1:5229 W. ARBEED DRIVE
Practice Address - Street 2:
Practice Address - City:ST. JAMES
Practice Address - State:LA
Practice Address - Zip Code:70086
Practice Address - Country:US
Practice Address - Phone:225-265-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator