Organization
G BRENT WHITTON MD AND WILLIS-KNIGHTON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-5970
Entity
Organization
Contact information
Practice address
2510 BERT KOUNS INDUSTRIAL LOOP, ROOM 215, SHREVEPORT, LA 71118-3119
(318) 212-5970
(318) 212-5975
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-5946
(318) 212-4153
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Enumeration date
07/06/2006
Last updated
07/23/2009
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