Healthcare Provider Details

I. General information

NPI: 1477582526
Provider Name (Legal Business Name): LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 S JOHNSON ST FL 6
NEW ORLEANS LA
70112-2238
US

IV. Provider business mailing address

478 S JOHNSON ST FL 6
NEW ORLEANS LA
70112-2238
US

V. Phone/Fax

Practice location:
  • Phone: 504-412-1819
  • Fax: 504-412-1954
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ATARA MCAVOY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 504-412-1819