Healthcare Provider Details

I. General information

NPI: 1962501726
Provider Name (Legal Business Name): TAMELA L MARCA CHARBONNET MD/LEE H GRAFTON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRAFTON DERM AND COSMETIC SURGERY 327 BAYOU GARDENS BLVD
HOUMA LA
70360
US

IV. Provider business mailing address

GRAFTON DERM AND COSMETIC SURGERY 327 BAYOU GARDENS BLVD
HOUMA LA
70360
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-5000
  • Fax: 985-876-5280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number023735
License Number StateLA

VIII. Authorized Official

Name: ANN BOURGEDIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 985-876-5000