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General NPI Number Information
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NPI Number | 1164683645
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Entity Type | Organization
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Legal Business Name | MCKENNA GENERAL MEDICAL, LLC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 1827 GENTILLY BLVD
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City | NEW ORLEANS
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State | LA
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Zip | 70119-2051
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Country | US
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Telephone | 504-943-1923
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Fax | 504-943-1933
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Provider Business Mailing Address
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Address Line | 1827 GENTILLY BLVD
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City | NEW ORLEANS
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State | LA
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Zip | 70119-2051
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Country | US
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Telephone | 504-943-1923
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Fax | 504-943-1933
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. DWIGHT LAWRENCE MCKENNA
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Credential | M.D.
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Telephone | 504-943-1923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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