Organization
HEADACHE & PAIN CENTER, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMY NOLAN PONDER JR. MD (OWNER/CEO)
(985) 580-1200
Entity
Organization
Contact information
Practice address
123 FRONTAGE A RD, GRAY, LA 70359-6301
(985) 580-1200
(985) 580-1218
Mailing address
123 FRONTAGE A RD, GRAY, LA 70359-6301
(985) 580-1200
(985) 580-1218
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1441708
—
LA
01
—
B5621
BC/BS PROVIDER NUMBER
LA
Enumeration date
05/24/2006
Last updated
08/08/2013
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