# SHREVEPORT FAMILY MEDICINE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003975079
- **Authorized official:** MRS. SHELIA L. JACKSON (ADMINISTRATOR)
- **Authorized official phone:** (318) 686-3770

## Contact information

- **Practice address:** 7505 PINES ROAD, SUITE 1250, SHREVEPORT, LA 71129-3927
- **Practice address phone:** (318) 686-3770
- **Practice address fax:** (318) 686-3838
- **Mailing address:** 7505 PINES RD, SUITE 1250, SHREVEPORT, LA 71129-3935
- **Mailing address phone:** (318) 686-3770
- **Mailing address fax:** (318) 686-3838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 06/16/2008