Healthcare Provider Details

I. General information

NPI: 1497863674
Provider Name (Legal Business Name): GRAHAM M REID MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10816 EXECUTIVE CENTER DR #101
LITTLE ROCK AR
72211-4354
US

IV. Provider business mailing address

10816 EXECUTIVE CENTER DRIVE SUITE 101
LITTLE ROCK AR
72211-4381
US

V. Phone/Fax

Practice location:
  • Phone: 501-221-3331
  • Fax: 501-221-3339
Mailing address:
  • Phone: 501-221-3331
  • Fax: 501-221-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC-5446
License Number StateAR

VIII. Authorized Official

Name: GRAHAM MACK REID
Title or Position: OWNER
Credential: MD
Phone: 501-221-3331