# WILLIS-KNIGHTON MEDICAL CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WILLIS-KNIGHTON MEDICAL CENTER, INC.
- **Other names:** A WK Clinic for Women - South
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790057735
- **Legal business name:** WILLIS-KNIGHTON MEDICAL CENTER, INC.
- **Authorized official:** GREG J GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-4232

## Contact information

- **Practice address:** 2508 BERT KOUNS LOOP, SUITE 105, SHREVEPORT, LA 71118-3133
- **Practice address phone:** (318) 212-8780
- **Practice address fax:** (318) 212-6752
- **Mailing address:** 2508 BERT KOUNS LOOP, SUITE 105, SHREVEPORT, LA 71118-3133
- **Mailing address phone:** (318) 212-8780
- **Mailing address fax:** (318) 212-6752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2012
- **Last updated:** 02/07/2012