SOUTHERN PEDIATRIC CLINIC NPI 1528432440

NPI Information

SOUTHERN PEDIATRIC CLINIC is a primary care clinic center in Shreveport, LA. SOUTHERN PEDIATRIC CLINIC NPI is 1528432440. The provider is registered as an organization entity type.
The provider Is Doing Business As Southern Pediatric Clinic.

The provider's business location address is:

202 N THOMAS DR
SUITE 1
SHREVEPORT, LA
ZIP 71107-539
Phone: (318) 221-0277

The provider's authorized official is Stella Immanuel .
The authorized official title is Owner and has the following contact phone number (318) 730-9760.

The enumeration date for this NPI number is 11/16/2015 and was last updated on 11/16/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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