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General NPI Number Information
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NPI Number | 1043965734
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Entity Type | Organization
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Legal Business Name | JMAC MEDICAL PLLC
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 403 MORROW ST N STE F
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City | MENA
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State | AR
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Zip | 71953-4324
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Country | US
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Telephone | 479-437-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 403 MORROW ST N STE F
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City | MENA
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State | AR
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Zip | 71953-4324
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES ROBERT MCWILLIAMS
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Credential |
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Telephone | 479-437-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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