Healthcare Provider Details

I. General information

NPI: 1386077303
Provider Name (Legal Business Name): SOUTHERN NEURO SPECIALTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E. ST. PETER STREET
CARENCRO LA
70520
US

IV. Provider business mailing address

P.O. BOX 187
CARENCRO LA
70520
US

V. Phone/Fax

Practice location:
  • Phone: 225-239-2301
  • Fax: 225-341-8526
Mailing address:
  • Phone: 225-235-2301
  • Fax: 225-341-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JAMES MICHAEL LANDRY
Title or Position: MANAGING PARTNER
Credential:
Phone: 337-739-4939