Individual
JULIANA MELODY FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
018938
LA
2084P0800X
Psychiatry Physician
K2469
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1361551
—
LA
Enumeration date
07/17/2006
Last updated
05/01/2024
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