Individual
JEREMY MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
114 ROYAL ST., NATCHITOCHES, LA 71457
(318) 527-6671
Mailing address
1717 MARSHALL ST, SHREVEPORT, LA 71101
(318) 527-6671
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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