Healthcare Provider Details

I. General information

NPI: 1801474325
Provider Name (Legal Business Name): ASHWINI GOTIMUKUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

IV. Provider business mailing address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-1539
  • Fax:
Mailing address:
  • Phone: 870-207-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberE-20526
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: