Healthcare Provider Details

I. General information

NPI: 1104266204
Provider Name (Legal Business Name): ADAM C MASSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN STE 405
HOT SPRINGS AR
71913-6441
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 501-609-2222
  • Fax: 501-321-9689
Mailing address:
  • Phone: 501-609-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-10852
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-10852
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: