Healthcare Provider Details

I. General information

NPI: 1578774881
Provider Name (Legal Business Name): AJA WELCH MENARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AJA WELCH M.D.

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71118-3119
US

IV. Provider business mailing address

1202 LOUISIANA AVE
SHREVEPORT LA
71101-3910
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5200
  • Fax: 318-212-5595
Mailing address:
  • Phone: 318-212-8574
  • Fax: 318-212-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.203155
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD.203155
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: