Healthcare Provider Details

I. General information

NPI: 1770872418
Provider Name (Legal Business Name): PHILLIP A BARKSDALE APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 AIRLINE HWY SUITE 650
BATON ROUGE LA
70815-4114
US

IV. Provider business mailing address

9000 AIRLINE HWY SUITE 650
BATON ROUGE LA
70815-4114
US

V. Phone/Fax

Practice location:
  • Phone: 225-928-9881
  • Fax: 225-928-5770
Mailing address:
  • Phone: 225-928-9881
  • Fax: 225-928-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number09178R
License Number StateLA

VIII. Authorized Official

Name: DR. PHILLIP ANTHONY BARKSDALE
Title or Position: CEO
Credential: MD
Phone: 225-928-9881