Healthcare Provider Details

I. General information

NPI: 1891754040
Provider Name (Legal Business Name): GENE WATKINS REID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 W MARKHAM ST SUITE 212
LITTLE ROCK AR
72205-2195
US

IV. Provider business mailing address

10201 W MARKHAM ST SUITE 212
LITTLE ROCK AR
72205-2195
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-6916
  • Fax: 501-227-8254
Mailing address:
  • Phone: 501-227-6916
  • Fax: 501-227-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC5579
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC5579
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: