Organization
MMG NELSON RD LLC
Active
Parent organization
MEMORIAL MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL MEDICAL GROUP
Authorized official
DAWN JOHNSON-HATCHER (CFO)
(337) 494-2094
Entity
Organization
Contact information
Practice address
4345 NELSON RD STE 102, LAKE CHARLES, LA 70605-4183
(337) 480-7900
(337) 602-6358
Mailing address
PO BOX 123594 DEPT 3594, DALLAS, TX 75312-3594
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/11/2015
Last updated
12/04/2023
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