Basic Information
| Provider Information | |||||||||
| NPI: | 1376552414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATH & ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5425 BRITTANY DR | ||||||||
| Address2: | STE A | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257673710 | ||||||||
| FaxNumber: | 2257678255 | ||||||||
| Practice Location | |||||||||
| Address1: | 5425 BRITTANY DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257673710 | ||||||||
| FaxNumber: | 2257678255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | KONGARA | ||||||||
| AuthorizedOfficialFirstName: | GOPINATH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2257673710 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 200639 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1448737 | 05 | LA | MEDICAID |