Healthcare Provider Details

I. General information

NPI: 1588922579
Provider Name (Legal Business Name): SAMUEL CLAY OVERLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 AUTUMN RD
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-526-1046
  • Fax: 501-320-7975
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-11395
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: