Organization
WILLIS KNIGHTON MEDICAL CENTER & M R MANCHANDIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 747-5272
Entity
Organization
Contact information
Practice address
2706 SHED RD, BOSSIER CITY, LA 71111-3348
(318) 747-5272
(318) 746-9669
Mailing address
2706 SHED RD, BOSSIER CITY, LA 71111-3348
(318) 747-5272
(318) 746-9669
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
06/25/2006
Last updated
06/12/2012
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