# SOUTHERN SPINE & ORTHOPAEDICS LLC

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

## Provider details

- **NPI number:** 1255168175
- **Authorized official:** KATHRYN CLARK (CREDENTIALING)
- **Authorized official phone:** (337) 706-1142

## Contact information

- **Practice address:** 105 PATRIOT ST STE 101, LAFAYETTE, LA 70508-6831
- **Practice address phone:** (337) 981-2125
- **Practice address fax:** (337) 981-2174
- **Mailing address:** 105 PATRIOT ST STE 101, LAFAYETTE, LA 70508-6831
- **Mailing address phone:** (337) 981-2125
- **Mailing address fax:** (337) 981-2174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/16/2024
- **Last updated:** 09/16/2024