Healthcare Provider Details

I. General information

NPI: 1083607782
Provider Name (Legal Business Name): FAMILY MEDICINE OF NEW ORLEANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RUE DE SANTE SUITE 7
LA PLACE LA
70068-5400
US

IV. Provider business mailing address

4208 MACON DR
KENNER LA
70065-1939
US

V. Phone/Fax

Practice location:
  • Phone: 985-359-3763
  • Fax: 985-359-2472
Mailing address:
  • Phone: 985-359-3763
  • Fax: 983-359-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025236
License Number StateLA

VIII. Authorized Official

Name: MRS. CELESTE ECKERT DAVIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 985-359-3763