Organization
SOUTHERN MEDICAL SERVICES OF LOUISIANA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES G GLADNEY (OWNER)
(318) 281-0078
Entity
Organization
Contact information
Practice address
1523 TEXAS AVE, BASTROP, LA 71220-4043
(318) 281-0078
(318) 281-2753
Mailing address
1523 TEXAS AVE, BASTROP, LA 71220-4043
(318) 281-0078
(318) 281-2753
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/26/2014
Last updated
02/26/2014
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