Healthcare Provider Details

I. General information

NPI: 1255541975
Provider Name (Legal Business Name): GEORGE T KESHELAVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 STARBRUSH CIR
COVINGTON LA
70433-7304
US

IV. Provider business mailing address

1810 LINDBERG DR STE 2100
SLIDELL LA
70458-8160
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-4155
  • Fax: 985-871-4183
Mailing address:
  • Phone: 985-871-4155
  • Fax: 985-871-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD.210497
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: