Healthcare Provider Details

I. General information

NPI: 1285307744
Provider Name (Legal Business Name): UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 DAILEY DR
LITTLE ROCK AR
72209-6215
US

IV. Provider business mailing address

9015 DAILEY DR
LITTLE ROCK AR
72209-6215
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-6560
  • Fax: 501-364-4020
Mailing address:
  • Phone: 501-364-6560
  • Fax: 501-364-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA D GEORGE
Title or Position: VICE CHANCELLOR-CHIEF FINANCIAL OFF
Credential:
Phone: 501-686-5670