Provider Demographics
NPI:1851952410
Name:NOLA CENTRAL CITY CLINIC
Entity Type:Organization
Organization Name:NOLA CENTRAL CITY CLINIC
Other - Org Name:NOLA CENTRAL CITY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAQUINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLAIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:504-952-0844
Mailing Address - Street 1:1301 SIMON BOLIVAR AVE APT 227
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-2272
Mailing Address - Country:US
Mailing Address - Phone:504-952-0844
Mailing Address - Fax:
Practice Address - Street 1:1301 SIMON BOLIVAR AVE APT 227
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-2272
Practice Address - Country:US
Practice Address - Phone:504-952-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA363L00000XMedicaid