Organization
SOUTHERN BARIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN GRAY (CEO)
(985) 234-3000
Entity
Organization
Contact information
Practice address
7015 HIGHWAY 190 EAST SERVICE RD, COVINGTON, LA 70433-4960
(985) 234-3000
(985) 234-3002
Mailing address
PO BOX 249, MADISONVILLE, LA 70447-0249
(985) 234-3000
(985) 234-3002
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
92030365
LA
Other
Enumeration date
07/25/2006
Last updated
08/22/2020
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