Organization
SOUTHERN VASCULAR ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RACHEED JOSEPH GHANAMI M.D. (PHYSICIAN)
(337) 356-1252
Entity
Organization
Contact information
Practice address
127 QUEENSBERRY DR, LAFAYETTE, LA 70508-5421
(337) 356-1252
Mailing address
127 QUEENSBERRY DR, LAFAYETTE, LA 70508-5421
(337) 356-1252
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
205214
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2315617
—
LA
Enumeration date
05/22/2015
Last updated
05/22/2015
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