Healthcare Provider Details

I. General information

NPI: 1114976867
Provider Name (Legal Business Name): JIMMIE W VARNADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 HWY 10
GREENSBURG LA
70441
US

IV. Provider business mailing address

6214 HWY 10 PO BOX 1178
GREENSBURG LA
70441
US

V. Phone/Fax

Practice location:
  • Phone: 225-222-3206
  • Fax: 225-222-3190
Mailing address:
  • Phone: 225-222-3206
  • Fax: 225-222-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011614
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: