Organization
ACCEPTANCE KIDMED OF LA, LLC
Active
Organization
ACCEPTANCE KIDMED OF LA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARITA DAVIS ACKLIN (OWNER)
(225) 928-5362
Entity
Organization
Contact information
Practice address
2156 WOODDALE BLVD, SUITE 140, BATON ROUGE, LA 70806-1403
(225) 928-5362
(225) 928-5363
Mailing address
2156 WOODDALE BLVD, SUITE 140, BATON ROUGE, LA 70806-1403
(225) 928-5362
(225) 928-5363
Taxonomy
Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLYING
—
LA
Enumeration date
11/19/2007
Last updated
11/19/2007
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