Organization
HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD L JACKSON (CHEIF EXECUTIVE OFFICE)
(318) 205-4075
Entity
Organization
Contact information
Practice address
4571 N MARKET ST, SHREVEPORT, LA 71107-2917
(318) 934-0097
(318) 934-0097
Mailing address
PO BOX 7312, SHREVEPORT, LA 71137-7312
(318) 205-4075
(318) 754-4134
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
08/10/2015
Last updated
08/10/2015
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