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Organization
MMG NELSON RD LLC
Active
Organization
MMG NELSON RD LLC
Active
Parent organization
MEMORIAL MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL MEDICAL GROUP
Authorized official
DAWN JOHNSON-HATCHER (CFO)
(337) 494-2094
Entity
Organization
Contact information
Practice address
4345 NELSON RD STE 102, LAKE CHARLES, LA 70605-4183
(337) 480-7900
(337) 602-6358
Mailing address
PO BOX 123594 DEPT 3594, DALLAS, TX 75312-3594
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/11/2015
Last updated
12/04/2023
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