MEDICARE: HEALING HANDS FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD.200657	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1750383618	OTHER		NPI

General Provider Information

NPI Number	:	1720198138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HANDS FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	6821 PINES RD
Second Line	:	SUITE 400
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2547
Country	:	US
Telephone Number	:	318-686-7109
Fax Number	:	318-687-7016

Provider Business Practice Location Address
First Line	:	6821 PINES RD
Second Line	:	SUITE 400
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2547
Country	:	US
Telephone Number	:	318-686-7109
Fax Number	:	318-687-7016

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MELITA JOYCE WILIAMS
Credential	:	M.D.
Telephone Number	:	318-686-7109

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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