Provider Demographics
NPI:1235520982
Name:GHATTAS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GHATTAS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THARWAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GHATTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-207-3206
Mailing Address - Street 1:2812 CARIBBEAN CV
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2763
Mailing Address - Country:US
Mailing Address - Phone:318-207-3206
Mailing Address - Fax:318-747-9994
Practice Address - Street 1:2812 CARIBBEAN CV
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2763
Practice Address - Country:US
Practice Address - Phone:318-207-3206
Practice Address - Fax:318-747-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206802390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty