Healthcare Provider Details

I. General information

NPI: 1003732793
Provider Name (Legal Business Name): SOUTHERN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 EWING DR
NEW ROADS LA
70760-2646
US

IV. Provider business mailing address

3422 EWING DR
NEW ROADS LA
70760-2646
US

V. Phone/Fax

Practice location:
  • Phone: 225-938-7142
  • Fax:
Mailing address:
  • Phone: 225-938-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MARIE RABALAIS
Title or Position: OWNER/MEMBER
Credential:
Phone: 225-938-7142