Healthcare Provider Details

I. General information

NPI: 1073763843
Provider Name (Legal Business Name): SOUTHERN MEDICAL SOULTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12441 LEGACY HILLS DR
GEISMAR LA
70734-3165
US

IV. Provider business mailing address

12441 LEGACY HILLS DR
GEISMAR LA
70734-3165
US

V. Phone/Fax

Practice location:
  • Phone: 504-909-8801
  • Fax: 225-313-6093
Mailing address:
  • Phone: 504-909-8801
  • Fax: 225-313-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS MICHAEL SHAY
Title or Position: OWNER
Credential:
Phone: 504-909-8801