# MMG NELSON RD LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEMORIAL MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1295103844
- **Legal business name:** MEMORIAL MEDICAL GROUP
- **Authorized official:** DAWN JOHNSON-HATCHER (CFO)
- **Authorized official phone:** (337) 494-2094

## Contact information

- **Practice address:** 4345 NELSON RD STE 102, LAKE CHARLES, LA 70605-4183
- **Practice address phone:** (337) 480-7900
- **Practice address fax:** (337) 602-6358
- **Mailing address:** PO BOX 123594 DEPT 3594, DALLAS, TX 75312-3594
- **Mailing address phone:** (337) 494-2921
- **Mailing address fax:** (337) 494-6523

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084N0400X | Neurology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2015
- **Last updated:** 12/04/2023