Organization
PHYSICIAN GROUP OF LOUISIANA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY KOCH (CFO)
(617) 562-7070
Entity
Organization
Contact information
Practice address
503 MCMILLAN RD, WEST MONROE, LA 71291-5327
(318) 329-4200
(318) 329-4710
Mailing address
PO BOX 281796, ATLANTA, GA 30384-1796
(866) 243-7107
(314) 432-9683
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1818593
—
LA
Enumeration date
03/12/2009
Last updated
03/06/2020
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