Healthcare Provider Details

I. General information

NPI: 1548068364
Provider Name (Legal Business Name): ARKANSAS HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COMMERCE DR
MAUMELLE AR
72113-6708
US

IV. Provider business mailing address

305 ROCK STREET SUITE 1409
LITTLE ROCK AR
72202
US

V. Phone/Fax

Practice location:
  • Phone: 870-472-8465
  • Fax: 870-472-8219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANDRAKANTH BODDU
Title or Position: OWNER/MEDICAL DOCTOR
Credential: MD
Phone: 929-229-8734