Healthcare Provider Details

I. General information

NPI: 1861438665
Provider Name (Legal Business Name): THOMAS W ATKINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E JOYCE BLVD
FAYETTEVILLE AR
72703-6214
US

IV. Provider business mailing address

PO BOX 9690
FAYETTEVILLE AR
72703-0030
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-5905
  • Fax: 479-582-5908
Mailing address:
  • Phone: 479-582-5905
  • Fax: 479-582-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberC-5953
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC-5903
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC-5953
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: