Organization
CAPITAL CITY MEDICAL GROUP, LLC
Active
Other names
Stanocola Clinic Ancillary Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE JOHNSON (CHIEF EXECUTIVE OFFICER)
(225) 926-7200
Entity
Organization
Contact information
Practice address
16777 MEDICAL CENTER DR, SUITE 400, BATON ROUGE, LA 70816-3254
(225) 952-8798
(225) 952-8502
Mailing address
3838 N CAUSEWAY BLVD, SUITE 2200, METAIRIE, LA 70002-8194
(225) 926-7200
(225) 952-8502
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2142674
—
LA
Enumeration date
12/21/2011
Last updated
12/21/2011
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