# SOUTH LOUISIANA WELLNESS SERVICES LLC

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

## Provider details

- **NPI number:** 1700257615
- **Authorized official:** PAMELA DUPONT NP (AGENT)
- **Authorized official phone:** (985) 856-7893

## Contact information

- **Practice address:** 4266 W MAIN ST STE 100, GRAY, LA 70359-6421
- **Practice address phone:** (985) 856-7893
- **Practice address fax:** (985) 346-6944
- **Mailing address:** 4266 W MAIN ST STE 100, GRAY, LA 70359-6421
- **Mailing address phone:** (985) 856-7893
- **Mailing address fax:** (985) 346-6944

## Taxonomy

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

## Other

- **Enumeration date:** 10/19/2015
- **Last updated:** 10/19/2015