Organization
WK PIERREMONT PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
1666 E BERT KOUNS LOOP, SUITE 220, SHREVEPORT, LA 71105-5714
(318) 212-2960
(318) 212-2967
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8574
(318) 212-4153
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
09/18/2009
Last updated
06/08/2012
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