Provider Demographics
NPI:1629877220
Name:MARTIN, JAMAL
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:MARTIN
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 1:1109 HOOTER RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70094-3468
Mailing Address - Country:US
Mailing Address - Phone:504-266-6750
Mailing Address - Fax:504-324-0403
Practice Address - Street 1:301 MAIN ST STE 22222223
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801-1919
Practice Address - Country:US
Practice Address - Phone:504-266-6750
Practice Address - Fax:504-324-0403
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide