Healthcare Provider Details

I. General information

NPI: 1205862877
Provider Name (Legal Business Name): NANCY GERMANY MD AND WILLIS-MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 PINES RD SUITE 100
SHREVEPORT LA
71129-2547
US

IV. Provider business mailing address

6821 PINES RD SUITE 100
SHREVEPORT LA
71129-2547
US

V. Phone/Fax

Practice location:
  • Phone: 318-687-5500
  • Fax: 318-687-5503
Mailing address:
  • Phone: 318-687-5500
  • Fax: 318-687-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG J. GAVIN
Title or Position: NETWORK ADMINISTRATOR
Credential:
Phone: 318-687-5500