Organization
SOUTHEAST NEUROSCIENCE CENTER, LLC
Active
Other names
Southeast Neuroscience Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GABRIEL LEE NUGENT (DIRECTOR)
(985) 850-6805
Entity
Organization
Contact information
Practice address
970 S ACADIA RD, THIBODAUX, LA 70301-4978
(985) 917-3007
(985) 447-4209
Mailing address
PO BOX 4051, HOUMA, LA 70361-4051
(985) 917-3007
(985) 917-3010
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1947482
—
LA
Enumeration date
05/28/2015
Last updated
11/05/2015
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