Organization
PONTCHARTRAIN PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE JONES (OFFICE MANAGER)
(985) 893-8505
Entity
Organization
Contact information
Practice address
4405 HIGHWAY 190 EAST SERVICE RD, COVINGTON, LA 70433-4957
(985) 893-8505
(985) 893-0093
Mailing address
4405 HIGHWAY 190 EAST SERVICE RD, COVINGTON, LA 70433-4957
(985) 893-8505
(985) 893-0093
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1442810
—
LA
Enumeration date
03/13/2007
Last updated
01/05/2011
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