Organization
SOUTHERN KIDNEY ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY HAGOOD RN (PRACTICE ADMINISTRATOR)
(903) 234-9992
Entity
Organization
Contact information
Practice address
1815 E 70TH ST, SHREVEPORT, LA 71105-5301
(800) 276-9017
(903) 234-9992
Mailing address
3535 N FOURTH ST STE 301, LONGVIEW, TX 75605-0037
(800) 276-9017
(903) 234-8287
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
10/24/2018
Last updated
10/06/2021
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