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General NPI Number Information
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NPI Number | 1346286804
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Entity Type | Organization
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Legal Business Name | BRIAN BABIAK MD AND WILLIS-KNIGHTON MEDICAL CENTER
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 2514 BERT KOUNS LOOP SUITE 7
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City | SHREVEPORT
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State | LA
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Zip | 71118-3146
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Country | US
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Telephone | 318-212-5801
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Fax | 318-212-5805
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Provider Business Mailing Address
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Address Line | 2514 BERT KOUNS LOOP SUITE 7
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City | SHREVEPORT
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State | LA
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Zip | 71118-3146
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Country | US
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Telephone | 318-212-5801
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Fax | 318-212-5805
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Authorized Official
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Title or Position | NETWORK ADMINISTRATOR
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Name | GREG J GAVIN
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Credential |
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Telephone | 318-212-5801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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