Healthcare Provider Details

I. General information

NPI: 1144481599
Provider Name (Legal Business Name): JACKSONVILLE NEUROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 RICHARDS RD SUITE C
NORTH LITTLE ROCK AR
72117-2650
US

IV. Provider business mailing address

PO BOX 875
NORTH LITTLE ROCK AR
72115-0875
US

V. Phone/Fax

Practice location:
  • Phone: 501-985-1323
  • Fax: 501-985-3229
Mailing address:
  • Phone: 501-985-1323
  • Fax: 501-985-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberE1201
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberE1201
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE1201
License Number StateAR

VIII. Authorized Official

Name: DR. CHARLES EDWARD SCHULTZ
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 501-985-1323