Healthcare Provider Details

I. General information

NPI: 1578481891
Provider Name (Legal Business Name): JAMES GANT PLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MEDEL MARCONI RD
MARION AR
72364-9047
US

IV. Provider business mailing address

204 MISSISSIPPI ST S
WYNNE AR
72396-3025
US

V. Phone/Fax

Practice location:
  • Phone: 870-208-8499
  • Fax:
Mailing address:
  • Phone: 870-208-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: