MEDICARE: NWABUEZE NNAMDI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	L12712R	LA
2	207R00000X	Internal Medicine Physician	L12712R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114047735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NWABUEZE NNAMDI INC

Provider Business Mailing Address
First Line	:	3050 CHARLES DR
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-6135
Country	:	US
Telephone Number	:	225-634-3517
Fax Number	:	225-635-5057

Provider Business Practice Location Address
First Line	:	3050 CHARLES DR
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-6135
Country	:	US
Telephone Number	:	225-634-3517
Fax Number	:	225-635-5057

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. STACIE N NWABUEZE
Credential	:	PH.D
Telephone Number	:	225-634-3517

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/06/2015

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Directions to “NWABUEZE NNAMDI INC ” Practice Location

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