Healthcare Provider Details

I. General information

NPI: 1689182412
Provider Name (Legal Business Name): SAVERITT PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 WILLOW CREEK DR STE 203
SPRINGDALE AR
72762-8708
US

IV. Provider business mailing address

2857 N DORCHESTER DR
FAYETTEVILLE AR
72703-3989
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-9359
  • Fax:
Mailing address:
  • Phone: 479-236-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberE2459
License Number StateAR

VIII. Authorized Official

Name: DR. SUSAN M AVERITT
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 479-236-7974