Healthcare Provider Details

I. General information

NPI: 1265621130
Provider Name (Legal Business Name): GEORGES ELIAS EL KHOURY ANTOUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 S HARRISON ST
COVINGTON LA
70433-3661
US

IV. Provider business mailing address

1006 S HARRISON ST
COVINGTON LA
70433-3661
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-4140
  • Fax: 985-898-4150
Mailing address:
  • Phone: 985-871-4140
  • Fax: 985-898-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24523
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD.206769
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.206769
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: