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General NPI Number Information
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NPI Number | 1376771154
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Entity Type | Organization
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Legal Business Name | AHP OF NORTHWESTERN LOUISIANA LLC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 385 BERT KOUNS INDUSTRIAL LOOP BUILDING 300
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City | SHREVEPORT
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State | LA
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Zip | 71106-8158
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Country | US
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Telephone | 318-212-0552
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Fax |
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Provider Business Mailing Address
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Address Line | 3079 PEACHTREE INDUSTRIAL BLVD
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City | DULUTH
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State | GA
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Zip | 30097-2215
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Country | US
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Telephone | 770-945-5330
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREGORY WACHOWIAK
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Credential |
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Telephone | 770-945-5330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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