Organization
STAT LAB SOUTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHENETRA J. SMITH RN (OWNER/OPERATOR)
(318) 745-5227
Entity
Organization
Contact information
Practice address
333 TEXAS AVE, SUITE 1300, SHREVEPORT, LA 71111
(318) 618-0298
(318) 618-0298
Mailing address
681 PICKETTS MILL DRIVE, SHREVEPORT, LA 71115
(318) 745-5227
(318) 618-0298
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN100044
LA
246RP1900X
Phlebotomy Technician
—
—
Other
Enumeration date
10/30/2017
Last updated
10/30/2017
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