Healthcare Provider Details

I. General information

NPI: 1518536234
Provider Name (Legal Business Name): NLR GI ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 SPRINGHILL DR STE 155
NORTH LITTLE ROCK AR
72117-2934
US

IV. Provider business mailing address

PO BOX 291832
NASHVILLE TN
37229-1832
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-5800
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOHNATHAN GOODWIN
Title or Position: MD/OWNER
Credential: MD
Phone: 615-620-2320