Provider Demographics
NPI:1023606506
Name:LOUISIANA ADDICITION TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:LOUISIANA ADDICITION TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:G
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-919-3009
Mailing Address - Street 1:1741 LARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2215
Mailing Address - Country:US
Mailing Address - Phone:504-919-3009
Mailing Address - Fax:504-304-1618
Practice Address - Street 1:3216 N TURNBULL DR STE B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5732
Practice Address - Country:US
Practice Address - Phone:504-373-6717
Practice Address - Fax:504-304-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty