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General NPI Number Information
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NPI Number | 1376130849
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Entity Type | Organization
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Legal Business Name | GG MEDICAL
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 4900 MEDICAL DR
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City | BOSSIER CITY
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State | LA
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Zip | 71112-4521
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Country | US
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Telephone | 318-747-9500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52133
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City | SHREVEPORT
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State | LA
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Zip | 71135-2133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THARWAT GHATTAS
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Credential | MD
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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