Individual
SUMATHA GHANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
920 OLIVER RD, MONROE, LA 71201-5702
(318) 807-3700
(318) 807-0014
Mailing address
130 DESIARD ST, SUITE 355, MONROE, LA 71201-7319
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD205575
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1929735
—
LA
Enumeration date
06/16/2009
Last updated
06/11/2019
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