Healthcare Provider Details

I. General information

NPI: 1497675656
Provider Name (Legal Business Name): GREAT SOUTH MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WARNER ST STE 105
LEESVILLE LA
71446-2821
US

IV. Provider business mailing address

105/107 WARNER ST
LEESVILLE LA
71446
US

V. Phone/Fax

Practice location:
  • Phone: 337-238-0027
  • Fax: 337-238-0227
Mailing address:
  • Phone: 337-238-0027
  • Fax: 337-238-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN R JOHNSON
Title or Position: SOLE MEMBER
Credential: DC
Phone: 337-238-0027