Healthcare Provider Details

I. General information

NPI: 1962206201
Provider Name (Legal Business Name): ALI AMJAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 UNITY RD STE B
CROSSETT AR
71635-9444
US

IV. Provider business mailing address

604 MAIN ST APT F
CROSSETT AR
71635-3439
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-9111
  • Fax:
Mailing address:
  • Phone: 929-606-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: