Healthcare Provider Details

I. General information

NPI: 1407047459
Provider Name (Legal Business Name): AMANDA G. CHISUM-PRICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 LEXINGTON AVE
FORT SMITH AR
72901-4943
US

IV. Provider business mailing address

PO BOX 402330
ATLANTA GA
30384-2330
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-7350
  • Fax: 479-709-7355
Mailing address:
  • Phone: 479-709-7399
  • Fax: 479-709-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-5310
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: