Provider Demographics
NPI:1457322273
Name:ALBRITTON, COREY G (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:G
Last Name:ALBRITTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3002
Mailing Address - Country:US
Mailing Address - Phone:318-878-3737
Mailing Address - Fax:318-878-8638
Practice Address - Street 1:501 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-3001
Practice Address - Country:US
Practice Address - Phone:318-878-6650
Practice Address - Fax:318-878-6321
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA022526OtherLICENSE
LA1493589Medicaid
5Y644Medicare ID - Type Unspecified
G53560Medicare UPIN