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Guru Prasad Ghanta, MD
Specialist in Leesville, Louisiana
NPI 1255310199

Guru Prasad Ghanta is a Specialist based in Leesville, LA. Guru Prasad Ghanta practices in Leesville, LA and has the professional credentials of MD. The NPI Number for Guru Prasad Ghanta is 1255310199 and holds a License No. 05477R (Louisiana).

The current practice location address for Guru Prasad Ghanta is 1015 W Fertitta Blvd, Leesville, LA and can be reached out via phone at 337-239-4130 and via fax at 337-238-4104.

Location: 1015 W Fertitta Blvd, Leesville, LA, 71446-4646
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1255310199
Provider Name
Guru Prasad Ghanta
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1015 W Fertitta Blvd, Leesville, LA, 71446-4646
Phone Number
337-239-4130
Fax Number
337-238-4104
Provider Enumeration Date
01/10/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1313998 05 LA
05477R 01 LA LA. STATE LICENSE
720946706 01 LA TAX ID #
institution
Provider Business Practice Location Address Details
Address
1015 W Fertitta Blvd
City
Leesville
State
Louisiana
Zip
71446-4646
Phone Number
337-239-4130
Fax Number
337-238-4104
person
Provider Business Mailing Address Details
Address
1015 W Fertitta Blvd
City
Leesville
State
Louisiana
Zip
71446-4646
Phone Number
337-239-4130
Fax Number
337-238-4104
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
05477R (Louisiana)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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