Provider Demographics
NPI:1235138355
Name:GRIER, MANDY BRAUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:BRAUD
Last Name:GRIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:LYNN
Other - Last Name:BRAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12525 PERKINS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1907
Mailing Address - Country:US
Mailing Address - Phone:225-769-2003
Mailing Address - Fax:225-767-3055
Practice Address - Street 1:12525 PERKINS RD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1907
Practice Address - Country:US
Practice Address - Phone:225-769-2003
Practice Address - Fax:225-767-3055
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200331208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1628271Medicaid
LA248221YJA2Medicare PIN
LA4M630D279Medicare PIN