Healthcare Provider Details

I. General information

NPI: 1023606506
Provider Name (Legal Business Name): LOUISIANA ADDICITION TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 N TURNBULL DR STE B
METAIRIE LA
70002-5732
US

IV. Provider business mailing address

1741 LARK ST
NEW ORLEANS LA
70122-2215
US

V. Phone/Fax

Practice location:
  • Phone: 504-373-6717
  • Fax: 504-304-1618
Mailing address:
  • Phone: 504-919-3009
  • Fax: 504-304-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYANT G GEORGE SR.
Title or Position: PHYSICIAN/MEMBER
Credential: MD
Phone: 504-919-3009