Organization
WILLIS-KNIGHTON MEDICAL CENTER, INC
Active
Parent organization
WILLIS-KNIGHTON MEDICAL CENTER, INC.
Other names
WK Tristate Neurology Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILLIS-KNIGHTON MEDICAL CENTER, INC.
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
2084N0400X
Neurology Physician
Primary
—
—
Other
Enumeration date
08/08/2011
Last updated
11/23/2011
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