South Louisiana Wellness Services LLC

NPI #1700257615 in Gray, Louisiana

Provider Information

NPI Number: 1700257615
Entity Type: Organization
Organization Name: South Louisiana Wellness Services LLC
Primary Specialty: General Practice
Enumeration Date: Oct 19, 2015
Last Updated: Oct 19, 2015

Practice Location

Address: 4266 W MAIN ST STE 100
City: Gray
State: Louisiana
ZIP Code: 70359-6421
Phone: (985) 856-7893

Authorized Official

Name: PAMELA DUPONT, NP
Title: AGENT
Phone: (985) 856-7893

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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