Healthcare Provider Details

I. General information

NPI: 1245116367
Provider Name (Legal Business Name): CLINIC ON MAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MAIN ST STE A
LITTLE ROCK AR
72202-3818
US

IV. Provider business mailing address

1423 SUTTON MEADOW LN
CORDOVA TN
38016-7631
US

V. Phone/Fax

Practice location:
  • Phone: 501-319-7074
  • Fax: 501-246-3343
Mailing address:
  • Phone: 901-214-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARTHURENE WILLIAMS
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 901-214-7835