Healthcare Provider Details

I. General information

NPI: 1669466777
Provider Name (Legal Business Name): SOUTH ARKANSAS NEPHROLOGY AND HYPERTENSION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 W 28TH AVE SUITE A
PINE BLUFF AR
71603-5050
US

IV. Provider business mailing address

2302 W 28TH AVE SUITE A
PINE BLUFF AR
71603-5050
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-1400
  • Fax: 870-536-5196
Mailing address:
  • Phone: 870-536-1400
  • Fax: 870-536-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE3969
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE0300
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE4018
License Number StateAR

VIII. Authorized Official

Name: DR. KHALID MAHMOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 870-536-1400