Healthcare Provider Details

I. General information

NPI: 1306366885
Provider Name (Legal Business Name): DOCTORS HEALTH GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CHURCH ST STE 203
JONESBORO AR
72401-4106
US

IV. Provider business mailing address

PO BOX 1331
JONESBORO AR
72403-1331
US

V. Phone/Fax

Practice location:
  • Phone: 870-934-1462
  • Fax: 870-932-5699
Mailing address:
  • Phone: 870-932-7024
  • Fax: 870-930-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN LIEBLONG
Title or Position: PRESIDENT
Credential:
Phone: 870-932-7024