# CAPITAL CITY MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Primary Care Plus
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487084943
- **Authorized official:** MR. PETER ALDEN KELLOGG (ASSOCIATE GENERAL COUNSEL)
- **Authorized official phone:** (504) 681-8532

## Contact information

- **Practice address:** 120 MEADOWCREST ST, SUITE 120, GRETNA, LA 70056-5255
- **Practice address phone:** (504) 620-5661
- **Practice address fax:** (504) 620-5674
- **Mailing address:** 3838 N CAUSEWAY BLVD, SUITE 2200, METAIRIE, LA 70002-8194
- **Mailing address phone:** (504) 681-8259
- **Mailing address fax:** (504) 681-8260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RR0500X | Rheumatology Physician | — | NULL | — |
| 207RR0500X | Rheumatology Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |

## Other

- **Enumeration date:** 11/20/2013
- **Last updated:** 05/12/2014