Organization
DONALD G MACK SR MD AND WILLIS-KNIGHTON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
1799 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5561
(318) 797-9000
(318) 797-9250
Mailing address
1799 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5561
(318) 797-9000
(318) 797-9250
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
11/28/2006
Last updated
08/22/2020
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