Provider Demographics
NPI:1497450068
Name:JOLLY, ANGELLE LEGER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELLE
Middle Name:LEGER
Last Name:JOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 GRAND LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7316
Mailing Address - Country:US
Mailing Address - Phone:337-661-9231
Mailing Address - Fax:
Practice Address - Street 1:814 GRAND LAKES DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7316
Practice Address - Country:US
Practice Address - Phone:337-661-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program