Healthcare Provider Details

I. General information

NPI: 1861644981
Provider Name (Legal Business Name): ALBERT LEE DOBBINS JR. MHPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S LAUREL ST
PINE BLUFF AR
71601-4859
US

IV. Provider business mailing address

1262 EUREKA GARDEN RD
NORTH LITTLE ROCK AR
72117-3115
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-4900
  • Fax: 870-534-4906
Mailing address:
  • Phone: 501-945-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: