Provider Demographics
NPI:1467182147
Name:AKINS, GABRIEL SR
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:AKINS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 CUBA BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2009
Mailing Address - Country:US
Mailing Address - Phone:318-499-2767
Mailing Address - Fax:
Practice Address - Street 1:2613 CUBA BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2009
Practice Address - Country:US
Practice Address - Phone:318-499-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor