Provider Demographics
NPI:1326465139
Name:ATCHAFALAYA INTERNAL MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:ATCHAFALAYA INTERNAL MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-329-2200
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381-3002
Mailing Address - Country:US
Mailing Address - Phone:985-329-2200
Mailing Address - Fax:985-329-2280
Practice Address - Street 1:1234 DAVID DR
Practice Address - Street 2:STE C
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1300
Practice Address - Country:US
Practice Address - Phone:985-329-2200
Practice Address - Fax:985-329-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty