Healthcare Provider Details

I. General information

NPI: 1952327645
Provider Name (Legal Business Name): ALEXANDRIA PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD SUITE 210
ALEXANDRIA LA
71301-3900
US

IV. Provider business mailing address

3311 PRESCOTT RD SUITE 210
ALEXANDRIA LA
71301-3900
US

V. Phone/Fax

Practice location:
  • Phone: 318-487-1477
  • Fax: 318-442-5814
Mailing address:
  • Phone: 318-487-1477
  • Fax: 318-442-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YASSER M NAKHLAWI III
Title or Position: OWNER AND CEO
Credential: M.D.
Phone: 318-487-1477