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General NPI Number Information
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NPI Number | 1013311976
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Entity Type | Organization
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Legal Business Name | SOUTH POINT HEALTHCARE PC
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 613 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730-4557
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Country | US
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Telephone | 870-881-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 13615 WOODBROOK DR
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3165
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Country | US
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Telephone | 678-357-6030
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MR. DAVID JERNIGAN
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Credential |
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Telephone | 870-881-8558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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