Individual
MR. JAVORIS ANTONIO HINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1639 RYAN ST, LAKE CHARLES, LA 70601-5948
(337) 602-6391
Mailing address
1639 RYAN ST, LAKE CHARLES, LA 70601-5948
(337) 602-6391
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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