Healthcare Provider Details

I. General information

NPI: 1649422726
Provider Name (Legal Business Name): ACADIANA RADIOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

PO BOX 4628
JACKSON MS
39296-4628
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2180
  • Fax: 337-470-2677
Mailing address:
  • Phone: 601-982-7878
  • Fax: 601-982-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOAN C WOJAK
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 337-470-2180