Provider Demographics
NPI:1518150127
Name:GADDIS MEDICAL & AESTHETICS, LLC
Entity Type:Organization
Organization Name:GADDIS MEDICAL & AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-238-9899
Mailing Address - Street 1:800 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4750
Mailing Address - Country:US
Mailing Address - Phone:337-238-9899
Mailing Address - Fax:337-239-2060
Practice Address - Street 1:800 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4750
Practice Address - Country:US
Practice Address - Phone:337-238-9899
Practice Address - Fax:337-239-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200147261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care