Individual
MARTESE BYRON CHILDRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSS SUP
Contact information
Practice address
3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
(225) 778-7678
(225) 341-6825
Mailing address
3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
(225) 778-7678
(225) 341-6825
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
OBHPSS1086
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OBHPSS1086
—
LA
Enumeration date
07/08/2025
Last updated
07/08/2025
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