Healthcare Provider Details

I. General information

NPI: 1831334051
Provider Name (Legal Business Name): PEDIATRIC GI SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FAIRFIELD AVE SUITE 305
SHREVEPORT LA
71101-4467
US

IV. Provider business mailing address

PO BOX 1283
SHREVEPORT LA
71163-1283
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-7769
  • Fax: 318-629-7768
Mailing address:
  • Phone: 318-629-7769
  • Fax: 318-629-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNNY ZAHEED HUSSAIN
Title or Position: OWNER
Credential: MD
Phone: 318-629-7769