Basic Information
| Provider Information | |||||||||
| NPI: | 1992807812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOURI | ||||||||
| FirstName: | THATTIL | ||||||||
| MiddleName: | PAVUNNY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 ENGLISH TURN DR | ||||||||
| Address2: | THATTIL P GOURI MD | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 79131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043922231 | ||||||||
| FaxNumber: | 5043628486 | ||||||||
| Practice Location | |||||||||
| Address1: | 3201 GENERAL MEYER AVE | ||||||||
| Address2: | STE C | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043628930 | ||||||||
| FaxNumber: | 5043628486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 04552R | LA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1942111 | 01 | LA | CLINIC | OTHER | 1194620 | 05 | LA | MEDICAID |