Individual
DR. JOHNNY KEVIN INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1154 LOGAN SEWELL DR, VIDALIA, LA 71373-3342
(318) 336-8166
(318) 336-8169
Mailing address
1154 LOGAN SEWELL DR, VIDALIA, LA 71373-3342
(318) 336-8166
(318) 336-8169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD200671
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1066435
—
IA
Enumeration date
05/13/2006
Last updated
02/10/2014
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