Organization
WK SHREVEPORT CENTER FOR GERIATRIC HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2508 BERT KOUNS LOOP, SUITE 303, SHREVEPORT, LA 71118-3133
(318) 212-5850
(318) 212-5855
Mailing address
2508 BERT KOUNS LOOP, SUITE 303, SHREVEPORT, LA 71118-3133
(318) 212-5850
(318) 212-5855
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1818798
—
LA
01
—
5DL73
MEDICARE PTAN
LA
Enumeration date
12/16/2009
Last updated
01/23/2014
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