OrganizationActive
Southern Pediatric Clinic
NPI 1104297720 · Health Service Clinic/Center · Shreveport, LA
Provider details
- NPI number
- 1104297720
- Entity type
- Organization
- Primary specialty
- Health Service Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Stella Immanuel, Owner
- License
- MD12866R (LA)
Practice location
202 N Thomas Dr
Suite 1
Shreveport, LA 71107-6539
Phone: (318) 221-0277
Fax: (318) 221-3277
Mailing address
202 N Thomas Dr
Shreveport, LA 71107-6539
Registry dates
- Enumerated
- 2015-10-08
- Last updated
- 2015-11-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.