Healthcare Provider Details

I. General information

NPI: 1982336277
Provider Name (Legal Business Name): SUHAIB FARAH MUFADI AL-SAWAJNEH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BIENVILLE ST STE A
NATCHITOCHES LA
71457-5740
US

IV. Provider business mailing address

107A SOUTH DR
NATCHITOCHES LA
71457-5039
US

V. Phone/Fax

Practice location:
  • Phone: 318-238-4604
  • Fax: 318-238-4605
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number354011
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: