Healthcare Provider Details

I. General information

NPI: 1265023030
Provider Name (Legal Business Name): MAJESTIC PEDIATRIC AND ADOLESCENT ACUTE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W WATERMAN ST
DUMAS AR
71639-2139
US

IV. Provider business mailing address

PO BOX 19
DUMAS AR
71639
US

V. Phone/Fax

Practice location:
  • Phone: 501-533-9320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GARTH
Title or Position: OWNER/PROVIDER
Credential: APRN
Phone: 501-533-9320