Healthcare Provider Details

I. General information

NPI: 1255254520
Provider Name (Legal Business Name): CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 SCENIC HWY
BATON ROUGE LA
70802-3380
US

IV. Provider business mailing address

PO BOX 66156
BATON ROUGE LA
70896-6156
US

V. Phone/Fax

Practice location:
  • Phone: 225-650-2070
  • Fax: 225-650-2071
Mailing address:
  • Phone: 225-650-2070
  • Fax: 225-650-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MAIMOUNA KEITA
Title or Position: CFO
Credential:
Phone: 225-650-2024