Healthcare Provider Details

I. General information

NPI: 1518220862
Provider Name (Legal Business Name): JUSTIN TODD HARNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

IV. Provider business mailing address

2501 RIVERFRONT DR APT. F-103
LITTLE ROCK AR
72202-1771
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-6000
  • Fax: 870-541-3198
Mailing address:
  • Phone: 870-541-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-8271
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: