Organization
GULF SOUTH PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARMINDER S MALLIK MD (PRESIDENT)
(985) 781-0548
Entity
Organization
Contact information
Practice address
1924 CORPORATE SQUARE DR, SUITE D, SLIDELL, LA 70458-3164
(985) 781-0548
(985) 781-4319
Mailing address
1924 CORPORATE SQUARE DR, SLIDELL, LA 70458-3164
(985) 781-0548
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
MD10912R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD10912R
STATE LICENSE10912R
LA
Enumeration date
02/07/2011
Last updated
02/07/2011
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