Provider Demographics
NPI:1477565323
Name:MCGANN, MARY BETH (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MCGANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:VALIULIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10120 THORNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7679
Mailing Address - Country:US
Mailing Address - Phone:318-286-4917
Mailing Address - Fax:318-797-3353
Practice Address - Street 1:7607 FERN AVE STE 204D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5699
Practice Address - Country:US
Practice Address - Phone:318-797-3350
Practice Address - Fax:318-797-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0250722084P0800X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry