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Organization
GRACE HEALTH CLINIC
Active
Organization
GRACE HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BIANCA D JACKSON (CLINIC ADMINISTRATOR)
(985) 259-4854
Entity
Organization
Contact information
Practice address
1415 CORPORATE SQUARE DR STE A, SLIDELL, LA 70458-3151
(985) 259-4854
(855) 807-4750
Mailing address
1415 CORPORATE SQUARE DR STE A, SLIDELL, LA 70458-3151
(985) 259-4854
(855) 807-4750
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05427361
—
MS
05
—
2427806
—
LA
Enumeration date
02/06/2019
Last updated
06/17/2021
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