Healthcare Provider Details

I. General information

NPI: 1033454723
Provider Name (Legal Business Name): PRIME PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 CALLAWAY LN
FORT SMITH AR
72916-8437
US

IV. Provider business mailing address

5808 CALLAWAY LN
FORT SMITH AR
72916-8437
US

V. Phone/Fax

Practice location:
  • Phone: 479-696-8880
  • Fax:
Mailing address:
  • Phone: 479-242-4455
  • Fax: 479-974-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KALYAN AKKINENI
Title or Position: PARTNER
Credential: MD
Phone: 423-426-3918