Healthcare Provider Details

I. General information

NPI: 1427080985
Provider Name (Legal Business Name): GEORGE GOLIGHTLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 SUMMA AVE
BATON ROUGE LA
70809-3726
US

IV. Provider business mailing address

9001 SUMMA AVE
BATON ROUGE LA
70809-3726
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5200
  • Fax: 225-761-5549
Mailing address:
  • Phone: 225-761-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL1363R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD13630R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: