Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southern Pediatric Clinic

Organization Health Service Clinic/Center · NPI 1104297720

Southern Pediatric Clinic is a Health Service Clinic/Center in Shreveport, Louisiana. Licensed in Louisiana. Registered with an NPI since 2015.

Licensed in
LA
In the registry since
2015

Practice location Address checks out

202 N Thomas Dr Ste 1
Shreveport, LA 71107-6539
Phone: (318) 221-0277
Fax: (318) 221-3277
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Health Service Clinic/Center (primary) Taxonomy 261QH0100X · Licence MD12866R (LA)

Record details

NPI number1104297720
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Stella Immanuel — Owner · (318) 221-0277
NPI enumeratedOctober 8, 2015
Last updated in NPPESNovember 3, 2015
Mailing address202 N Thomas Dr, Suite 1, Shreveport, LA 71107-6539

Other providers in Shreveport