Healthcare Provider Details

I. General information

NPI: 1831131499
Provider Name (Legal Business Name): CHANDRA M KATTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7414 SUMRALL DR SUITE C
BATON ROUGE LA
70812-1240
US

IV. Provider business mailing address

5718 FIR LANE
LAKE CHARLES LA
70605-8122
US

V. Phone/Fax

Practice location:
  • Phone: 225-448-2937
  • Fax: 225-246-8936
Mailing address:
  • Phone: 337-478-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number08484R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: