Healthcare Provider Details

I. General information

NPI: 1942321013
Provider Name (Legal Business Name): ARKANSAS ALLERGY & ASTHMA CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST SUITE 222
LITTLE ROCK AR
72205-2175
US

IV. Provider business mailing address

2039 WEST MAIN STREET SUITE C
CABOT AR
72023
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-5210
  • Fax: 501-221-2443
Mailing address:
  • Phone: 501-227-5210
  • Fax: 501-221-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: TOMMY JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-227-5210