# MCKENNA GENERAL MEDICAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164683645
- **Authorized official:** DR. DWIGHT LAWRENCE MCKENNA M.D. (PRESIDENT/PHYSICIAN)
- **Authorized official phone:** (504) 943-1923

## Contact information

- **Practice address:** 1827 GENTILLY BLVD, NEW ORLEANS, LA 70119-2051
- **Practice address phone:** (504) 943-1923
- **Practice address fax:** (504) 943-1933
- **Mailing address:** 1827 GENTILLY BLVD, NEW ORLEANS, LA 70119-2051
- **Mailing address phone:** (504) 943-1923
- **Mailing address fax:** (504) 943-1933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/18/2008
- **Last updated:** 08/12/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1129267 | — | LA |
| 01 | — | 436664206B | BLUE CROSS/BLUE SHIELD | LA |
| 01 | — | F4229 | BLUE CROSS/BLUE SHIELD | LA |
| 01 | — | UP4206 | UNITED HEALTHCARE | LA |