| Gg Medical | |
|
4900 Medical Dr Bossier City LA 71112-4521 | |
| (318) 747-9500 | |
| Not Available |
| Full Name | Gg Medical |
|---|---|
| Speciality | Internal Medicine |
| Location | 4900 Medical Dr, Bossier City, Louisiana |
| Authorized Official Name and Position | Tharwat Ghattas (OWNER) |
| Authorized Official Contact | 3182073206 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gg Medical Po Box 52133 Shreveport LA 71135-2133 Ph: () - | Gg Medical 4900 Medical Dr Bossier City LA 71112-4521 Ph: (318) 747-9500 |
| NPI Number | 1376130849 |
|---|---|
| Provider Enumeration Date | 12/30/2020 |
| Last Update Date | 02/25/2021 |
| Medicare PECOS PAC ID | 2860809969 |
|---|---|
| Medicare Enrollment ID | O20210407000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376130849 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kathleen E Deville |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124276621 PECOS PAC ID: 9032275698 Enrollment ID: I20090305000477 |
| Provider Name | Tharwat A Ghattas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043523277 PECOS PAC ID: 0840424636 Enrollment ID: I20140729000067 |
| Provider Name | Paul T Guidry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700143237 PECOS PAC ID: 0345488482 Enrollment ID: I20160629001185 |
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