Provider Demographics
NPI:1740399344
Name:ACADIANA FAMILY MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ACADIANA FAMILY MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-334-7551
Mailing Address - Street 1:717 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-8311
Mailing Address - Country:US
Mailing Address - Phone:337-334-7551
Mailing Address - Fax:337-334-7556
Practice Address - Street 1:717 CURTIS DR
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-8311
Practice Address - Country:US
Practice Address - Phone:337-334-7551
Practice Address - Fax:337-334-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1440078Medicaid
LA1440078Medicaid