# ALL AGE MEDICAL P.C., INC.

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

## Provider details

- **NPI number:** 1548440811
- **Authorized official:** DR. ANDREA NATALIE BLAKE-MCMAHON M.D. (CEO)
- **Authorized official phone:** (318) 741-8100

## Contact information

- **Practice address:** 2910 SHED RD, SUITE B, BOSSIER CITY, LA 71111-3154
- **Practice address phone:** (318) 741-8100
- **Practice address fax:** (318) 741-5700
- **Mailing address:** 2910 SHED RD, SUITE B, BOSSIER CITY, LA 71111-3154
- **Mailing address phone:** (318) 741-8100
- **Mailing address fax:** (318) 741-5700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 14851R | LA | Yes |

## Other

- **Enumeration date:** 11/05/2007
- **Last updated:** 01/20/2012