| NPI | 1730633926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY WAYNE PHILLIPS Manager 504-309-8135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2019-10-08 |