Healthcare Provider Details

I. General information

NPI: 1174644140
Provider Name (Legal Business Name): JOSHUA WOOLLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR BUILDING 170 UNIT 1L
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

2200 FORT ROOTS DR BUILDING 170 UNIT 1L
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3324
  • Fax:
Mailing address:
  • Phone: 501-257-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberE-7048
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: