MEDICARE: TOTAL HEALTH FAMILY MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1962970582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL HEALTH FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	9435 MANSFIELD RD STE 5B
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3859
Country	:	US
Telephone Number	:	318-686-3770
Fax Number	:	318-686-3838

Provider Business Practice Location Address
First Line	:	9435 MANSFIELD RD STE 5B
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3859
Country	:	US
Telephone Number	:	318-686-3770
Fax Number	:	318-686-3838

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LETATIA VANCE-NORRIS
Credential	:	DHSC
Telephone Number	:	318-686-3770

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	10/22/2021

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