Healthcare Provider Details

I. General information

NPI: 1548230550
Provider Name (Legal Business Name): GRAHAM MACK REID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10816 EXECUTIVE CENTER DR SUITE 101
LITTLE ROCK AR
72211-4384
US

IV. Provider business mailing address

10816 EXECUTIVE CENTER DR SUITE 101
LITTLE ROCK AR
72211-4384
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 Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC-5446
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: