# OVERTON BROOKS VA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548404361
- **Authorized official:** WAYLON MALMAY BSRT (R) (T) (RADIATION THERAPIST)
- **Authorized official phone:** (318) 332-1589

## Contact information

- **Practice address:** 510 E STONER AVE, SHREVEPORT, LA 71101-4243
- **Practice address phone:** (318) 221-8411
- **Mailing address:** 4855 AIRLINE DR APT 37D, BOSSIER CITY, LA 71111-6652
- **Mailing address phone:** (318) 332-1589

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 286500000X | Military Hospital | — | NULL | Yes |

## Other

- **Enumeration date:** 04/23/2009
- **Last updated:** 04/23/2009