Organization
ABUNDANT HEALTH MEDICAL CLINIC, LLC
Active
Other names
Abundant Health Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADRIENNE CHANELLE ROBERTSON M.D. (MEDICAL DIRECTOR)
(334) 294-2758
Entity
Organization
Contact information
Practice address
1001 JACKSON ST, THIBODAUX, LA 70301-3227
(985) 492-9111
(985) 492-9114
Mailing address
PO BOX 5011, THIBODAUX, LA 70302-5011
(985) 492-9111
(985) 492-9114
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2371231.
—
LA
Enumeration date
10/22/2015
Last updated
10/22/2015
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