Organization
NWABUEZE NNAMDI INC
Active
Other names
EAST FELICIANA PRIMARY CARE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACIE N NWABUEZE PH.D (ADMINISTRATOR)
(225) 634-3517
Entity
Organization
Contact information
Practice address
3050 CHARLES DR, JACKSON, LA 70748-6135
(225) 634-3517
(225) 635-5057
Mailing address
3050 CHARLES DR, JACKSON, LA 70748-6135
(225) 634-3517
(225) 635-5057
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L12712R
LA
208D00000X
General Practice Physician
L12712R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1552232
—
LA
05
—
2330241
—
LA
Enumeration date
03/29/2007
Last updated
07/06/2015
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