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General NPI Number Information
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NPI Number | 1336992437
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Entity Type | Organization
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Legal Business Name | DIVINITY DIAGNOSTIC & WELLNESS INC
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 2002 20TH ST STE B202
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City | KENNER
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State | LA
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Zip | 70062-4403
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Country | US
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Telephone | 504-667-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 20TH ST STE B202
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City | KENNER
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State | LA
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Zip | 70062-4403
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Country | US
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Telephone | 504-667-3641
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATEDA T WILLIAMS
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Credential | CMA
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Telephone | 504-274-6023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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