Individual
EBONY JUAKALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2750 GAUSE BLVD E, SLIDELL, LA 70461-4149
(985) 639-3777
(985) 639-3701
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25251
MS
207Q00000X
Family Medicine Physician
25251
MS
207Q00000X
Family Medicine Physician
Primary
325147
LA
208M00000X
Hospitalist Physician
25251
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08204878
—
MS
Enumeration date
03/23/2016
Last updated
03/02/2021
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