Healthcare Provider Details

I. General information

NPI: 1285663955
Provider Name (Legal Business Name): GEORGE A MCCRARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N SALEM RD SUITE 6
FAYETTEVILLE AR
72704
US

IV. Provider business mailing address

PO BOX 1523
FAYETTEVILLE AR
72702-1523
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-0006
  • Fax: 479-442-3038
Mailing address:
  • Phone: 479-571-6038
  • Fax: 479-582-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC-3261
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: