Organization
WKN TRISTATE NEUROLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 240, SHREVEPORT, LA 71103-3981
(318) 212-8675
(318) 212-8680
Mailing address
2551 GREENWOOD RD, SUITE 240, SHREVEPORT, LA 71103-3981
(318) 212-8675
(318) 212-8680
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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