# MANDEVILLE PRIVATE PHYSICIAN GROUP

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

## Provider details

- **NPI number:** 1437553617
- **Authorized official:** DR. RICHARD MICHAEL JEANSONNE JR. MD (PHYSICIAN)
- **Authorized official phone:** (985) 630-9618

## Contact information

- **Practice address:** 141 LAKEVIEW CIR, COVINGTON, LA 70433-7513
- **Practice address phone:** (985) 630-9618
- **Practice address fax:** (985) 231-7010
- **Mailing address:** PO BOX 335, MANDEVILLE, LA 70470-0335
- **Mailing address phone:** (985) 630-9618
- **Mailing address fax:** (985) 231-7010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 025708 | LA | Yes |

## Other

- **Enumeration date:** 10/16/2014
- **Last updated:** 05/01/2017