Provider Demographics
NPI:1568423895
Name:MCNALLY, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4138
Mailing Address - Country:US
Mailing Address - Phone:337-824-1111
Mailing Address - Fax:337-824-1122
Practice Address - Street 1:1322 ELTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4138
Practice Address - Country:US
Practice Address - Phone:337-824-1111
Practice Address - Fax:337-824-1122
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA450506014OtherTAX ID
LA1423297Medicaid
H46507Medicare UPIN
LA450506014OtherTAX ID