Healthcare Provider Details

I. General information

NPI: 1255960696
Provider Name (Legal Business Name): UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 SHUFFIELD DR
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax: 501-526-5148
Mailing address:
  • Phone: 501-526-8400
  • Fax: 501-526-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA D GEORGE
Title or Position: UAMS CENTER FOR ADDICTION SERVICES
Credential:
Phone: 501-686-6633