Healthcare Provider Details

I. General information

NPI: 1659389278
Provider Name (Legal Business Name): LEE A. DAVIS, JR, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 DOLLARWAY RD STE 301
WHITE HALL AR
71602-3084
US

IV. Provider business mailing address

7500 DOLLARWAY RD STE 301
WHITE HALL AR
71602-3084
US

V. Phone/Fax

Practice location:
  • Phone: 870-850-0800
  • Fax: 870-850-0801
Mailing address:
  • Phone: 870-850-0800
  • Fax: 870-850-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE2239
License Number StateAR

VIII. Authorized Official

Name: DR. LEE ANDREW DAVIS JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 870-850-0800