Most Relevant Information
Provider Data
| NPI Number: | 1003443995 |
| Provider Name: | JAVONN WASHINGTON NICHOLAS |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/23/2020 |
| Last Updated: | 03/23/2020 |
Provider Practice Location
805 N BEECH ST
TALLULAH
LA
712823809
Practice Location Phone/Fax
| Phone: | 3185740098 |
| Fax: |
Provider Mailing Location
805 N BEECH ST
TALLULAH
LA
712823809
Provider Mailing Phone/Fax
| Phone: | 3185740098 |
| Fax: |