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General NPI Number Information
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NPI Number | 1235520982
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Entity Type | Organization
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Legal Business Name | GHATTAS MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 2812 CARIBBEAN CV
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City | SHREVEPORT
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State | LA
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Zip | 71105-2763
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Country | US
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Telephone | 318-207-3206
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Fax | 318-747-9994
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Provider Business Mailing Address
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Address Line | 2812 CARIBBEAN CV
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City | SHREVEPORT
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State | LA
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Zip | 71105-2763
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Country | US
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Telephone | 318-207-3206
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Fax | 318-747-9994
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Authorized Official
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Title or Position | OWNER
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Name | DR. THARWAT GHATTAS
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Credential | M.D.
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Telephone | 318-207-3206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 206802
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License Number State | LA
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